The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis.

Pubmed ID: 21821849

Journal: European heart journal

Publication Date: July 1, 2012

MeSH Terms: Humans, Male, Female, Aged, Risk Factors, Randomized Controlled Trials as Topic, Heart Failure, Cause of Death, Stroke Volume

Authors: Ahmed A, Ahmed A, McAlister FA, Thompson SG, Rich MW, Rich MW, Brett M, Wood DA, Doughty RN, Doughty RN, Doughty RN, Doughty RN, Doughty RN, McMurray JJ, Whalley GA, Whalley GA, Whalley GA, Whalley GA, Ezekowitz J, Ezekowitz J, Squire IB, Coats AJ, Andersson B, Andersson B, Pfeffer MA, Martínez-Sellés M, Martínez-Sellés M, Poppe K, Poppe K, Poppe K, Poppe K, Earle N, Tribouilloy C, Tribouilloy C, Swedberg K, Swedberg K, Swedberg K, Køber L, Køber L, Køber L, Berry C, Berry C, Berry C, Squire I, Whalley G, Hall C, Richards AM, Troughton R, Troughton R, Lainchbury J, Hogg K, Norrie J, Stevenson K, McMurray J, McMurray J, Granger CB, Michelson EL, Olofsson B, Yusuf S, Torp-Pedersen C, Lenzen MJ, Scholte op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, Cleland J, Komajda M, Komajda M, Gotsman I, Gotsman I, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Grigorian-Shamagian L, Grigorian-Shamagian L, Varela-Roman A, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Gonzalez-Juanatey JR, Gonzalez-Juanatey JR, Guazzi M, Guazzi M, Myers J, Arena R, Armstrong PW, Cujec B, Paterson I, Cowie MR, Suresh V, Poole-Wilson PA, Sutton GC, Robles JA, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Almendral J, Tarantini L, Tarantini L, Faggiano P, Senni M, Senni M, Lucci D, Lucci D, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Macín SM, Perna ER, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Bayes-Genis A, Bayes-Genis A, Vazquez R, Puig T, Fernandez-Palomeque C, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, Bayes de Luna A, Newton JD, Blackledge HM, Wright SP, Kerzner R, Gage BF, Freedland KE, Freedland KE, Huynh BC, Rovner A, Carney RM, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsutsui H, Tsutsui H, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Cubbon R, Cubbon R, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F, Pocock S, Pocock S, Granger C, Massie B, McAlister F, McAlister F, Somaratne J, Cowie M, Gonzalez-Juanatey J, Gorini M, Kearney M, di Lenarda A, Lenzen M, Macín S, Madsen B, Maggioni A, Oliva F, Rich M, Richards M, Taffet G, Dobson J, Held P, Bardají A, Canella JP, Östergren J, Perera K

Cite As: Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 2012 Jul;33(14):1750-7. Epub 2011 Aug 6.

Studies:

Abstract

AIMS: A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF). METHODS AND RESULTS: We compared survival in patients with HF-PEF with that in patients with HF-REF in a meta-analysis using individual patient data. Preserved EF was defined as an EF ≥ 50%. The 31 studies included 41 972 patients: 10 347 with HF-PEF and 31 625 with HF-REF. Compared with patients with HF-REF, those with HF-PEF were older (mean age 71 vs. 66 years), were more often women (50 vs. 28%), and have a history of hypertension (51 vs. 41%). Ischaemic aetiology was less common (43 vs. 59%) in patients with HF-PEF. There were 121 [95% confidence interval (CI): 117, 126] deaths per 1000 patient-years in those with HF-PEF and 141 (95% CI: 138, 144) deaths per 1000 patient-years in those with HF-REF. Patients with HF-PEF had lower mortality than those with HF-REF (adjusted for age, gender, aetiology, and history of hypertension, diabetes, and atrial fibrillation); hazard ratio 0.68 (95% CI: 0.64, 0.71). The risk of death did not increase notably until EF fell below 40%. CONCLUSION: Patients with HF-PEF have a lower risk of death than patients with HF-REF, and this difference is seen regardless of age, gender, and aetiology of HF. However, absolute mortality is still high in patients with HF-PEF highlighting the need for a treatment to improve prognosis.