What does this research mean for the field?

HFpEF patients had lower all-cause mortality (RR 0.78), CV mortality (RR 0.64), and HF hospitalizations (RR 0.75) compared to HFrEF patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This analysis aims to compare clinical outcomes, focusing on morbidity and mortality, between HFpEF and HFrEF patients.

January 18, 2026Open Access

Mortality and HF Hospitalizations in HFpEF Compared to HFrEF: A Systematic Review and Meta-Analysis

Key Result

HFpEF patients had lower all-cause mortality (RR 0.78), CV mortality (RR 0.64), and HF hospitalizations (RR 0.75) compared to HFrEF patients.

Key Points

This analysis aims to compare clinical outcomes, focusing on morbidity and mortality, between HFpEF and HFrEF patients.
Conducted a systematic review and meta-analysis of 101 studies.
Compared all-cause mortality, cardiovascular mortality, and hospitalizations between HFpEF and HFrEF.
Used risk ratios and hazard ratios with confidence intervals.
HFpEF patients had lower all-cause mortality (RR: 0.78) compared to HFrEF.
CV mortality was also lower in HFpEF patients (RR: 0.64).
HF hospitalizations were reduced in HFpEF (RR: 0.75) versus HFrEF.

Structured PICO

Does heart failure with preserved ejection fraction (HFpEF) have different mortality and hospitalization risks compared to heart failure with reduced ejection fraction (HFrEF)?

Population

Patients with heart failure across 101 pooled studies, specifically comparing those with heart failure with preserved ejection fraction (HFpEF, EF >50%) and heart failure with reduced ejection fraction (HFrEF, EF <40%).

Intervention

Heart failure with preserved ejection fraction (HFpEF, EF >50%)

Comparator

Heart failure with reduced ejection fraction (HFrEF, EF <40%)

Outcome

All-cause mortality, cardiovascular (CV) mortality, and HF hospitalizationshard clinical

This large-scale meta-analysis demonstrates that while HFpEF patients have lower relative risks of mortality and HF hospitalization compared to HFrEF, their absolute event rates remain high, underscoring the need for targeted therapies.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background and aims The global burden of heart failure (HF) is rising, with a shift toward more cases of HFpEF. Given evolving epidemiology, an updated assessment of outcome differences between HFpEF and HFrEF is needed. This systematic review and meta-analysis aimed to provide a contemporary, large-scale comparison of clinical outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Methods A systematic review and meta-analysis were conducted to compare all-cause mortality, cardiovascular (CV) mortality, and HF hospitalizations in HFpEF (EF 50%) and HFrEF (EF 40%). Risk ratios (RR) and maximally adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled using random-effects models. Additional analyses included prior HF hospital admissions, in-hospital mortality, and length of hospital stay. Results A total of 101 studies were included. HFpEF patients had lower all-cause mortality RR: 0.78; 95% CI: 0.69–0.88; p 0.001; adjusted HR: 0.71; 95% CI: 0.62–0.80; p 0.001; 112 vs 148 per 1000 patient-years (PY), CV mortality RR: 0.64; 95% CI: 0.53–0.79; p 0.001; adjusted HR: 0.65; 95% CI: 0.56–0.75; p 0.001; 73 vs 110 per 1000 PY, and HF hospitalizations RR: 0.75; 95% CI: 0.63–0.91; p = 0.003; adjusted HR: 0.87; 95% CI: 0.78–0.98; p = 0.02; 171 vs 225 per 1000 PY compared to HFrEF. Conclusions HFpEF patients experience lower mortality and hospitalization risks than HFrEF patients, even after adjustment for confounders. However, high absolute event rates in HFpEF highlight the need for effective treatment strategies to improve outcomes.