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

Eur J Heart Fail. 2009 Sep;11(9):855-62. doi: 10.1093/eurjhf/hfp103. Epub 2009 Aug 4.


Aims: 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.

Methods and results: 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).

Conclusion: 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.

Publication types

  • Meta-Analysis

MeSH terms

  • Aged
  • Cardiotonic Agents / therapeutic use
  • Confidence Intervals
  • Disease Progression
  • Female
  • Heart Failure / drug therapy*
  • Humans
  • Male
  • Odds Ratio
  • Prognosis
  • Stroke Volume / drug effects*
  • Ventricular Function, Left / drug effects*


  • Cardiotonic Agents