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

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.