Physicians' Academy for Cardiovascular Education

Higher mortality in HFrEF patients compared to those with HFmrEF or HFpEF

Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study

Literature - Lam CSP, Gamble GD, Ling LH, et al. - Eur Heart J 2018; published on line ahead of print

Introduction and methods

There are conflicting data regarding the similarity in prevalence and mortality risk of patients with heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) [1-4].

This prospective study compared the survival over a follow-up period of 2 years of patients with HFpEF to that of patients with HFmrEF and HFrEF, using international real world data. Adults from New Zealand and Singapore, with a clinical HF diagnosis within 6 months of an episode of decompensated HF, were included in the study. The endpoints were all-cause death and hospitalization for HF (HFH). Patients with severe valve disease, transient acute pulmonary edema due to an acute coronary syndrome, end-stage renal failure, constrictive pericarditis, congenital heart disease, hypertrophic cardiomyopathy, cardiac amyloidosis, chemotherapy-associated cardiomyopathy, isolated right HF, life-threatening co-morbidity with life expectancy <1 year and inability to provide consent, were excluded from the study.

Main results


In a prospective real world study conducted in Singapore and New Zealand, the risk of all-cause death was comparable in HFpEF and HFmrEF patients and higher in HFrEF patients. The risk of death or HF hospitalization was lower for HFpEF compared with HFrEF or HFmrEF.


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Find this article online at Eur Heart J

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