Key result
Heart failure with improved ejection fraction (HFimpEF) was associated with a 56% lower risk of all-cause mortality compared to heart failure with persistently reduced ejection fraction (HR 0.44).
Why the study?
The prevalence and prognosis of HFimpEF were inconsistent across prior studies, and no systematic review and meta-analysis had evaluated them.
Does developing HFimpEF improve mortality and hospitalization outcomes in patients with HFrEF?
Meta-Analysis (n=9,491)
Does developing HFimpEF improve mortality and hospitalization outcomes in patients with HFrEF?
Hazard Ratio: 0.44 (95% CI 0.33–0.6)
Approximately 22.6% of HFrEF patients develop HFimpEF, which is associated with a 56% reduction in mortality risk and a 60% reduction in cardiac hospitalization compared to persistent HFrEF.
Supports ongoing GDMT in HFimpEF despite better prognosis; leaves open interventions to promote LVEF recovery from HFrEF.
Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF. Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes. Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92). Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422 , identifier: CRD42021260422.
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He et al. (2021) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) (n=9,491). Heart failure with improved ejection fraction (HFimpEF) vs. Heart failure with reduced ejection fraction (HFrEF) was evaluated on All-cause mortality (HR 0.44, 95% CI 0.33-0.60). Heart failure with improved ejection fraction (HFimpEF) was associated with a 56% lower risk of all-cause mortality compared to heart failure with persistently reduced ejection fraction (HR 0.44).
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