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Meta-Analysis
. 2022 Dec;9(6):4088-4099.
doi: 10.1002/ehf2.14125. Epub 2022 Aug 31.

Long-term mortality in heart failure with mid-range ejection fraction: systematic review and meta-analysis

Deep Chandh Raja  1   2   3   4 , Indira Samarawickrema  2   4 , Souvik Das  3   4 , Abhinav Mehta  1 , Lukah Tuan  1   4 , Sanjiv Jain  2 , Sanjay Dixit  5 , Frank Marchlinski  5 , Walter P Abhayaratna  1   3 , Prashanthan Sanders  6 , Rajeev K Pathak  1   2   3   4
Affiliations
Meta-Analysis

Long-term mortality in heart failure with mid-range ejection fraction: systematic review and meta-analysis

Deep Chandh Raja et al. ESC Heart Fail. 2022 Dec.

Abstract

Aims: Heart failure patients with mid-range ejection fraction (HFmrEF) have overlapping clinical features, compared with patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We aim to perform a meta-analysis of studies reporting long-term outcomes in HFmrEF compared with HFrEF and HFpEF.

Methods and results: Data from 18 eligible large-scale studies including 126 239 patients were pooled. Patients with HFmrEF had a lower risk of all-cause death than those with HFrEF [risk ratio (RR) = 0.92; 95% CI = 0.85-0.98; P < 0.001]. This significant difference was seen in the follow-up at 1, 2, and 3 years. Patients with HFmrEF had significantly lower risk of cardiovascular (CV) deaths than HFrEF (RR = 0.77; 95% CI = 0.65-0.92; P < 0.001). Subgroup analysis showed that studies recruiting >50% of males had higher risk of deaths with HFrEF (RR = 1.15; 95% CI = 1.04-1.26; P = 0.006). When compared with HFpEF, patients with HFmrEF had comparable risk of all-cause death (RR = 1.02; 95% CI = 0.96-1.09; P = 0.53). Similarly, there were no differences in the 1, 2, and 3 year deaths; CV and non-CV deaths were insignificant between HFmrEF and HFpEF.

Conclusions: The results of the study support that HFmrEF has better prognosis than HFrEF but similar prognosis when compared with HFpEF. Gender disparity between studies seems to influence the results between HFmrEF and HFrEF. Transition in left ventricular ejection fraction (LVEF), which could not be addressed in the study, may play a decisive role in determining outcomes. PROSPERO review registration number CRD42021277107.

Keywords: Gender differences; Heart failure; Meta-analysis; Mid-range ejection fraction; Mortality; Systematic review.

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Conflict of interest statement

Dr Sanders reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and PaceMate. Dr Sanders reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, and Boston Scientific. Dr Sanders reports that the University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, BD, and Microport. All other authors have no disclosures. Dr Pathak reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific. Dr Pathak reports that Canberra Heart Rhythm Foundation has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, Boston Scientific and Biotronik. Dr Pathak reports that Canberra Heart Rhythm Foundation has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, and Biotronik.

Figures

Figure 1
Figure 1
Flow chart of search process and results.
Figure 2
Figure 2
Forest plots demonstrating all‐cause deaths in (A) HFmrEF and HFrEF, and (B) HFmrEF and HFpEF. HFmrEF, heart failure with mid‐range (borderline) ejection fraction; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.
Figure 3
Figure 3
Forest plots of sub‐group analysis of long‐term all‐cause mortality in (A) HFmrEF and HFrEF, and (B) HFmrEF and HFpEF. HFmrEF, heart failure with mid‐range (borderline) ejection fraction; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.
Figure 4
Figure 4
Forest plots demonstrating annual all‐cause deaths in (A) HFmrEF and HFrEF, and (B) HFmrEF and HFpEF. HFmrEF, heart failure with mid‐range (borderline) ejection fraction; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.
Figure 5
Figure 5
Forest plots demonstrating cardiovascular deaths in (A) HFmrEF and HFrEF, and (B) HFmrEF and HFpEF. HFmrEF, heart failure with mid‐range (borderline) ejection fraction; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.
See this image and copyright information in PMC

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