OBJECTIVES : HF can be categorised by ejection fraction (EF) into HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF). A review was undertaken to understand cause-specific burden of mortality in patients with HFpEF.

METHODS : Literature search of English publications of last seven years (2012-2018) was performed in Embase® and MEDLINE®. Search terms were variations on ‘HF’ and ‘mortality’. All type of primary observational (non-interventional) studies reporting mortality in HFpEF were included.

RESULTS : Of 2,748 citations reviewed, 48 studies met inclusion criteria and reported mortality in HFpEF patients. Thirty-nine of 48 studies provided a comparison of mortality estimates between HFpEF and HFrEF. Estimates forall-cause, cardiovascular (CV), HF, and non-CV mortality at 1 year follow-up among HFpEF patients ranged from 5.8-35.6%, 2.9-14.1%, 0.7-8.5%, and 1.9-4.6%, respectively. The variability across studies may be attributed to differences in baseline comorbidities, age of patient population, sample size, and how cause-specific mortality was attributed. In studies comparing HFpEF and HFrEF, 7/12, 2/8, and 3/5 studies showed significantly higher CV, HF, and sudden death rates in HFrEF as compared to HFpEF patients, respectively. However, 3/8 studies observed significantly higher non-CV mortality in HFpEF patients as compared to HFrEF. Though not significant, majority of other studies followed the same trend. In all-cause mortality, there was less difference between HFpEF and HFrEF, as higher non-CV mortality in HFpEF and higher CV mortality in HFrEF tended to equalize, although some studies reported somewhat higher rates in HFrEF.

CONCLUSIONS : There was considerable variability in mortality estimates across different studies. However, comparisons between HFrEF and HFpEF were broadly consistent with higher CV mortality, HF mortality and sudden death rates in HFrEF than in HFpEF. Non-CV mortality constituted a higher proportion of deaths in HFpEF than in HFrEF.