The prognosis of mid-range ejection fraction heart failure: a systematic review and meta-analysis

Aims: Mid-range ejection fraction is a new entity of heart failure (HF) with undetermined prognosis till now. In our systematic review and meta-analysis, we assess the mortality and hospitalization rates in mid-range ejection fraction HF (HFmrEF) and compare them with those of reduced ejection fraction heart failure (HFrEF) and preserved ejection fraction HF (HFpEF). Methods and results: We conducted our search in March 2018 in the following databases for relevant articles: PubMed, CENTRAL, Google Scholar, Web of Science, Scopus, NYAM, SIEGLE, GHL, VHL, and POPLINE. Our primary endpoint was assessing all-cause mortality and all-cause hospital re-admission rates in HFmrEF in comparison with HFrEF and HFpEF. Secondary endpoints were the possible causes of death and hospital re-admission. Twenty-five articles were included in our meta-analysis with a total of 606 762 adult cardiac patients. Our meta-analysis showed that HFmrEF had a lower rate of all-cause death than had HFrEF [relative risk (RR), 0.9; 95% confidence interval (CI), 0.85–0.94]. HFpEF showed a higher rate of cardiac mortality than did HFmrEF (RR, 1.09; 95% CI, 1.02–1.16). Also, HFrEF had a higher rate of non-cardiac mortality than had HFmrEF (RR, 1.31; 95% CI, 1.22–1.41). Conclusions: We detected a significant difference between HFrEF and HFmrEF regarding all-cause death, and non-cardiac death, while HFpEF differed significantly from HFmrEF regarding cardiac death.