Why the study?
Advanced HF carries a high symptom burden and mortality, and identifying the right time for palliative and advanced-therapy discussions remains difficult. This study systematically reviewed the prognostic value of serological biomarkers, echocardiographic indices, and patient-reported outcomes in advanced HF.
Population
Approximately 31,849 patients with advanced HF across 37 studies
Design
Systematic review and random-effects meta-analysis
Answers are grounded in this paper and cite their sources.
May aid timing of palliative/advanced HF therapy discussions; leaves open optimal biomarker-echo-PRO combinations for risk stratification.
Background/Objectives: Advanced heart failure (HF) carries a high symptom burden and mortality, and identifying the right time for palliative and advanced-therapy discussions remains difficult. We systematically reviewed the prognostic value of serological biomarkers, echocardiographic indices, and patient-reported outcomes (PROs) in advanced HF. Methods: PubMed, Scopus, Web of Science, and the Cochrane Library were searched on 1 June 2026 for studies published within the prior 10 years, following PRISMA 2020 (PROSPERO CRD420261505929). Risk of bias was assessed with the Newcastle–Ottawa Scale and certainty of evidence with GRADE. Hazard ratios (HRs) for all-cause mortality were pooled with random-effects models within pathophysiologically defined serological subgroups; markers with opposing prognostic directions were synthesized narratively. Results: Of 3866 records, 37 studies (approximately 31,849 patients) were included; 29 (78%) were at low risk of bias. The pooled HR was 1.35 (95% CI 1.06–1.74; k = 4; I2 = 92%) for neurohormonal/congestive markers; exploratory two-study estimates were 1.75 (1.50–2.04; I2 = 6%) for renal/cardiorenal and 2.17 (0.85–5.52; I2 = 86%) for inflammatory-nutritional markers. GRADE certainty was Low for the renal/cardiorenal estimate and Very Low for the other two, and funnel-plot asymmetry suggested small-study effects. Echocardiographic and PRO markers were individually associated with prognosis but showed opposing directions within outcome categories and were not pooled. Conclusions: Serological, echocardiographic, and patient-reported markers each carry prognostic information in advanced HF, but the pooled estimates are exploratory. Most studies assessed mortality or hospitalization rather than palliative or advanced-therapy decisions; relevance to such decisions is interpretive and requires prospective confirmation.
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Dramba et al. (2026) studied this question.
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