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August 27, 2026ESC Heart FailureOpen Access

Anaemia and all-cause mortality in contemporary heart failure with preserved ejection fraction (left ventricular ejection fraction ≥50%): an updated systematic review and meta-analysis

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Why the study?

Pooled prognostic estimates for anaemia in HFpEF predate the contemporary LVEF >=50% definition and combine legacy with contemporary cohorts.

Does WHO-defined anaemia increase all-cause mortality in patients with heart failure with preserved ejection fraction?

Population

109 909 HFpEF patients across 17 cohort studies

Comparison

Binary WHO-defined anaemia vs no anaemia

Design

Systematic review and meta-analysis

Follow-up

12-72 months

Key result

WHO-defined anaemia is independently associated with a higher risk of all-cause mortality in contemporary heart failure with preserved ejection fraction (LVEF ≥50%) (aHR 1.41; 95% CI 1.26-1.57).

Authors

STSuyash TripathiDJDharmendra Jain

Discussion

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Overview

Anaemia may refine mortality risk stratification in HFpEF; extends meta-analytic support to contemporary LVEF ≥50% cohorts while leaving treatment effects open.

Study Design

Type

Meta-Analysis (n=109,909)

Structured PICO

Does WHO-defined anaemia increase all-cause mortality in patients with heart failure with preserved ejection fraction?

P
Population
109,909 patients with heart failure with preserved ejection fraction from 17 cohort studies, with an anaemia prevalence of 26%-70% and follow-up of 12-72 months.
E
Exposure
Presence of WHO-defined anaemia
C
Comparator
Absence of WHO-defined anaemia
O
Outcome
All-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.41 (95% CI 1.26–1.57)

WHO-defined anaemia is independently associated with a ~40-50% higher all-cause mortality in HFpEF, a finding that remains robust under the contemporary LVEF ≥50% definition.

Limitations

  • Small-study effects were detected (Egger P = .03)
  • Small-study effects detected (Egger P = .03)

Cite This Study

Tripathi et al. (2026) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=109,909). WHO-defined anaemia vs. No anaemia was evaluated on All-cause mortality (aHR 1.41, 95% CI 1.26-1.57). WHO-defined anaemia is independently associated with a higher risk of all-cause mortality in contemporary heart failure with preserved ejection fraction (LVEF ≥50%) (aHR 1.41; 95% CI 1.26-1.57).

synapsesocial.com/papers/6aa353d5037baa32b3554977https://doi.org/10.1093/eschf/xvag213
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