Characteristics and Long-Term Prognosis of Patients with Heart Failure and Mid-Range Ejection Fraction Compared with Reduced and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Why the study?
Does HFmrEF have a distinct clinical profile and prognosis compared to HFrEF and HFpEF?
Population
109,257 patients with heart failure pooled from 12 eligible observational studies
Comparison
Heart failure with mid-range ejection fraction vs Heart failure with reduced ejection fraction and…
Design
Meta-analysis
Follow-up
mean 31 ± 5 months
Authors
Discussion
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Implication
HFmrEF's lower mortality supports distinct risk stratification; extends evidence for phenotype-specific prognosis in heart failure.
Key Points
- To evaluate the clinical features, all-cause mortality, cardiovascular mortality, and hospitalization rates of heart failure with mid-range ejection fraction compared to reduced and preserved ejection fraction subtypes.
- Meta-analysis pooling data from 12 eligible observational studies totaling 109,257 patients with heart failure.
- Evaluated demographic factors, comorbidities, medication use, and clinical outcomes over a mean follow-up of 31 ± 5 months across HFmrEF, HFrEF, and HFpEF cohorts.
- All-cause mortality was significantly lower in HFmrEF (26.8%) compared with HFrEF (29.5%; RR 0.95, 95% CI 0.93–0.98, P < 0.001) and HFpEF (31.0%; RR 0.97, 95% CI 0.94–0.99, P = 0.014).
- Cardiovascular mortality was lowest in HFmrEF (9.7%) compared to HFrEF (13.0%; RR 0.81, 95% CI 0.73–0.91, P < 0.001) and HFpEF (12.8%; RR 1.10, 95% CI 0.97–1.24, P = 0.13).
- Heart failure hospitalization in HFmrEF was 23.9%, compared with 27.6% in HFrEF (RR 0.89, 95% CI 0.85–0.93, P < 0.001) and 23.3% in HFpEF (RR 1.12, 95% CI 1.07–1.17, P < 0.001).
Structured PICO
Does HFmrEF have a distinct clinical profile and prognosis compared to HFrEF and HFpEF?
P
Population
109,257 patients with heart failure pooled from 12 eligible observational studies
I
Intervention
Heart failure with mid-range ejection fraction (HFmrEF)
C
Comparator
Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF)
O
Outcome
All-cause mortality, cardiovascular mortality, and heart failure hospitalization at mean follow-up of 31 ± 5 monthshard clinical
HFmrEF represents a distinct clinical phenotype with intermediate baseline characteristics between HFrEF and HFpEF, but is associated with the lowest all-cause and cardiovascular mortality among the three groups.
Cite This Study
Lauritsen et al. (2018) studied this question.