Characteristics and long‐term prognosis of patients with reduced, mid‐range, and preserved ejection fraction: A systemic review and meta‐analysis

AIMS: Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction. We performed a meta‐analysis to compare baseline characteristics and long‐term outcomes of patients with heart failure with reduced (HFrEF), mid‐range (HFmrEF), and preserved ejection fraction (HFpEF). METHODS AND RESULTS: A total of 27 prospective studies were included. Patients with HFpEF were older and had a higher proportion of females, hypertension, diabetes, and insufficient neuroendocrine antagonist treatments, while patients with HFrEF and HFmrEF had a higher prevalence of coronary heart disease and chronic kidney disease. After more than 1‐year of follow‐up, all‐cause mortality was significantly lower in patients with HFmrEF 9388/25 042 (37.49%) than those with HFrEF 39 333/90 023 (43.69%) and HFpEF 24 828/52 492 (47.30%) (p < .001). Cardiovascular mortality was lowest in patients with HFpEF 1130/9904 (11.41%), highest in patients with HFrEF 3419/16 277 (21.07%) mainly coming from HF death and sudden cardiac death, and middle in patients with HFmrEF 699/5171 (13.52%) and the non‐cardiovascular mortality was on the contrary. Subgroup analysis showed that in high‐risk patients with atrial fibrillation, the all‐cause mortality of HFpEF was significantly higher than both HFrEF and HFmrEF (p < .001). HF hospitalization was lowest in patients with HFmrEF 1822/5285 (34.47%), highest in patients with HFrEF 12 607/28 590 (44.10%) and middle in patients with HFpEF 8686/22 763 (38.16%) and the composite of all‐cause mortality and HF hospitalization was also observed similar results. CONCLUSIONS: In summary, patients with HFmrEF had the lowest incidence of all‐cause mortality and HF hospitalization, while the highest all‐cause mortality and HF hospitalization rates were HFpEF and HFrEF patients, respectively.