The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction : an individual patient data meta-analysis : meta-analysis global group in chronic heart failure (maggic)

Journal article

Stewart, S., Cubbon, R., Ezekowitz, Justin, González-Juanatey, José Ramón, Gorini, M., Gotsman, I., Grigorian Shamagian, L., Guazzi, M., Kearney, M., Kober, Lars, Komajda, Michel, Di Lenarda, A., Lenzen, Mattie, Lucci, D., McMurray, John, Macín, S., Madsen, B., Maggioni, Aldo, Martinez-Selles, Manuel, ... Dobson, Joanna. (2013). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction : an individual patient data meta-analysis : meta-analysis global group in chronic heart failure (maggic). European Heart Journal. 33(14), pp. 1750-1757. https://doi.org/10.1093/eurheartj/ehr254
AuthorsStewart, S., Cubbon, R., Ezekowitz, Justin, González-Juanatey, José Ramón, Gorini, M., Gotsman, I., Grigorian Shamagian, L., Guazzi, M., Kearney, M., Kober, Lars, Komajda, Michel, Di Lenarda, A., Lenzen, Mattie, Lucci, D., McMurray, John, Macín, S., Madsen, B., Maggioni, Aldo, Martinez-Selles, Manuel, McAlister, Finlay, Oliva, F., Poppe, K., Rich, Michael, Richards, M., Senni, Michele, Squire, Iain, Taffet, G., Tarantini, L., Tribouilloy, Christophe, Troughton, R., Tsutsui, Hiroyuki, Whalley, Gillian A., Earle, Nikki, Perera, K., Poppe, Katrina K., Dobson, J., Pocock, Stuart, Andersson, B., Hall, C., Richards, A.M., Lainchbury, J., Berry, C., Hogg, K., Norrie, J., Stevenson, K., Brett, M., Pfeffer, Marc A., Sweberg, Karl, Granger, Christopher B., Held, P., Michelson, Eric L., Olofsson, B., O¨ stergren, J., Yusuf, Salim and Dobson, Joanna
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.

KeywordsHeart failure; Prognosis; Meta-analysis
Year01 Jan 2013
JournalEuropean Heart Journal
Journal citation33 (14), pp. 1750-1757
PublisherOxford University Press
ISSN1522-9645
Digital Object Identifier (DOI)https://doi.org/10.1093/eurheartj/ehr254
Web address (URL)https://academic.oup.com/eurheartj/article/33/14/1750/525898#8227196
Open accessPublished as non-open access
Research or scholarlyResearch
Page range1750-1757
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online06 Aug 2011
Publication process dates
Accepted04 Jul 2011
Deposited02 May 2024
Supplemental file
License
All rights reserved
File Access Level
Controlled
Additional information

Copyright The Author 2011.

The MAGGIC meta-analysis was supported by grants from the New Zealand National Heart Foundation, The University of Auckland and The University of Glasgow. These sponsors had no role in the design, conduct, data management, and analysis; or in the manuscript preparation or review; or in the authorization for submission.

Place of publicationUnited Kingdom
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