The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis.

Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
European Journal of Heart Failure (Impact Factor: 5.25). 09/2009; 11(9):855-62. DOI: 10.1093/eurjhf/hfp103
Source: PubMed

ABSTRACT Heart failure (HF) with normal or preserved left ventricular (LV) ejection fraction (HFPEF) has been reported to be associated with similar outcome as HF with reduced EF (HFREF) in registry-based and epidemiological analyses, but many of these studies excluded patients who did not have EF measurements. Conversely, prior prospective studies have reported better outcome for patients with HFPEF. We performed a meta-analysis of prospective observational studies comparing all-cause mortality in patients with HFREF and HFPEF.
We searched several online databases for studies comparing outcome in HFREF and HFPEF, published before 2007. Inclusion criteria: prospective, clinical HF, near complete EF data, and mortality outcome. Review Manager version 4.2.3 software was used for the analysis. Overall, 24 501 patients [9299 deaths (38%)] from 17 studies are included. Average follow-up was 47 months; the HFPEF group was older (69 vs. 66 years) and more likely to be female (44% vs. 26%). Of the 7688 patients with HFPEF 2468 died (32.1%), compared with 6831 of the 16 813 patients with HFREF (40.6%): odds ratio 0.51 (95% CI: 0.48, 0.55).
This literature-based meta-analysis demonstrates that mortality among patients with HFPEF was half that observed in those with HFREF, in contrast to previous reports suggesting that mortality may be similar between both groups.

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    ABSTRACT: Heart failure with preserved ejection fraction (HF-PEF) represents a heterogenous group of patients with HF, more commonly affecting older women, with a history of hypertension and, less commonly, coronary disease, than patients with HF with reduced ejection fraction (HF-REF). Patients with HF-PEF have lower short-term and longer-term mortality than patients with HF-REF. At present, therapeutic interventions that have had proven benefits for patients with HF with reduced EF have not been shown to have similar benefits for patients with HF-PEF and there remains an urgent need for new therapeutic strategies to improve the clinical outcomes for patients with HF-PEF.
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