Mortality in heart failure with preserved ejection fraction: an unacceptably high rate

This editorial refers to ‘The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis’, by Meta-analysis Global Group in Chronic Heart Failure (MAGGIC), doi:10.1093/eurheartj/ehr254 One important factor that has contributed to our thinking about heart failure in patients with normal or preserved ejection fraction (HFpEF) has been the perception that mortality in this group of patients is similar to that in those of heart failure patients with reduced ejection fraction (HFrEF). This may derive largely from the results of two prior independent epidemiological studies that showed that mortality in these two groups of patients did not differ substantially ( Figure 1A and B ).1,2 Furthermore, the study by Owan et al .1, which collected patient outcome data spanning the time period from 1987 to 2001, showed that there was no improvement in HFpEF mortality trends over each successive 4 year time period. This contrasted to the improvement in 5-year survival of patients with HFrEF from ∼27% to ∼35%, which was interpreted as reflecting the introduction and adoption of new medical therapies and implantable cardioverter-defibrillators (ICDs) over this time period. Figure 1 Comparison of survival between HFrEF and HFpEF from two epidemiological studies1,2 and an individual patient data meta-analysis including results of randomized studies.4 Note that although the differences in survival in A were statistically significant ( P = 0.03, with >4500 patients included in the analysis) the difference at any time point is small. Adapted from Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355 :251–259, and Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP. Outcome of …