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European Journal of Heart Failure Advance Access originally published online on August 4, 2009
European Journal of Heart Failure 2009 11(9):855-862; doi:10.1093/eurjhf/hfp103
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis

Jithendra B. Somaratne1, Colin Berry2, John J.V. McMurray3, Katrina K. Poppe1, Robert N. Doughty1 and Gillian A. Whalley1,*

1 Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
2 The University of Glasgow, Glasgow, UK
3 The Western Infirmary, Glasgow, UK

* Corresponding author. Tel:+64 9 923 9813, Fax: +64 9 367 7146, Email: g.whalley{at}auckland.ac.nz


  Abstract

Aims: Heart failure (HF) with normal or preserved left ventricular (LV) ejection fraction (HFPEF) has been reported to be associated with similar outcome as HF with reduced EF (HFREF) in registry-based and epidemiological analyses, but many of these studies excluded patients who did not have EF measurements. Conversely, prior prospective studies have reported better outcome for patients with HFPEF. We performed a meta-analysis of prospective observational studies comparing all-cause mortality in patients with HFREF and HFPEF.

Methods and results: We searched several online databases for studies comparing outcome in HFREF and HFPEF, published before 2007. Inclusion criteria: prospective, clinical HF, near complete EF data, and mortality outcome. Review Manager version 4.2.3 software was used for the analysis. Overall, 24 501 patients [9299 deaths (38%)] from 17 studies are included. Average follow-up was 47 months; the HFPEF group was older (69 vs. 66 years) and more likely to be female (44% vs. 26%). Of the 7688 patients with HFPEF 2468 died (32.1%), compared with 6831 of the 16 813 patients with HFREF (40.6%): odds ratio 0.51 (95% CI: 0.48, 0.55).

Conclusion: This literature-based meta-analysis demonstrates that mortality among patients with HFPEF was half that observed in those with HFREF, in contrast to previous reports suggesting that mortality may be similar between both groups.

Key Words: Meta-analysis • Heart failure • Mortality • Preserved ejection fraction

Received May 21, 2009; Revised June 24, 2009; Accepted June 24, 2009


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