Key result
Ramadan fasting yields ~0.7% HF hospitalization rate with high completion in stable chronic HF.
Why the study?
Many adults with chronic HF fast during Ramadan despite religious exemption, motivating a summary of clinical outcomes in fasting patients and a comparison of acute HF admissions during Ramadan versus adjacent months.
Does Ramadan fasting increase the risk of heart failure hospitalization in adults with chronic heart failure?
Meta-Analysis (n=1,591)
Does Ramadan fasting increase the risk of heart failure hospitalization in adults with chronic heart failure?
While heart failure hospitalizations during Ramadan were infrequently reported among selected stable patients, very low certainty of evidence, selection bias, and wide confidence intervals prevent concluding that Ramadan fasting is safe in chronic heart failure.
Answers are grounded in this paper and cite their sources.
Very low-certainty evidence precludes concluding Ramadan fasting is safe in HF; leaves open need for randomized trials before practice change.
Many adults with chronic heart failure (HF) fast during Ramadan despite religious exemption. This study summarized outcomes in fasting patients with HF and compared acute HF admissions in Ramadan with adjacent months. Database, registry, and citation searches identified reports through October 2026. Observational studies of adults with HF who fasted and studies comparing HF admissions across calendar periods were eligible. Proportions were pooled using a binomial-normal mixed model, with Freemanâ"Tukey sensitivity analysis. Risk of bias and certainty were assessed; independent duplicate screening and extraction remain pending. From 4,804 records, 15 studies (20 reports) were included: eight patient-level cohorts (1,591 patients in seven reporting sample sizes) and seven admission-level studies. Three cohorts reported HF hospitalization during Ramadan (7/390; pooled 0.7%, 95% confidence interval [CI] 0.0â"15.7%; Freemanâ"Tukey 0.6%, 95% CI 0.0â"8.5%). One cohort reported comparative HF admissions over Ramadan plus six months (risk ratio 1.21, 95% CI 0.41â"3.53). Fasting completion was 93.3% (95% CI 89.4â"95.9%; 411/442). The exploratory inpatient admission-rate ratio was 0.99 (95% CI 0.82â"1.19; two studies). Certainty was very low. In selected, stable patients who fasted, HF hospitalization during Ramadan was infrequently reported. Sparse observational evidence, selection bias, and wide uncertainty prevent a conclusion that fasting is safe.
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Osman et al. (2026) conducted a meta-analysis in Chronic heart failure (n=1,591). Ramadan fasting vs. Non-fasting or adjacent calendar months was evaluated on Heart failure hospitalization during Ramadan (RR 1.21, 95% CI 0.41-3.53). Ramadan fasting in selected, stable adults with chronic HF had a pooled HF hospitalization rate of 0.7% (95% CI 0.0-15.7%) and 93.3% fasting completion.
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