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Eur Heart J. 2012 Jul;33(14):1750-7. doi: 10.1093/eurheartj/ehr254. Epub 2011 Aug 6.

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

Collaborators (221)

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

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.

PMID:
21821849
DOI:
10.1093/eurheartj/ehr254
[Indexed for MEDLINE]

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