The Prognosis and Predictors of Recovered Ejection Fraction Heart Failure: A Systematic Review and Meta-analysis

Abstract

Introduction HFrecEF is a new entity included among the other types of heart failure. It represents the improvement of LVEF above the upper limit of HFrEF which usually ranges from 40 to 55%. Hypothesis We aimed to assess the predictors, measures of mortality and hospitalization of HFrecEF to compare it with HFrEF and HFpEF. Methods We conducted a systematic search in eight databases; PubMed, Scopus, Web of Science, Google Scholar, New York Academy of Medicine (NYAM), System for Information on Grey Literature in Europe (SIGLE), Global Health Library (GHL) and Virtual Health Library (VHL). Our primary endpoint was assessing the prognosis of HFrecEF in comparison with HFrEF and HFpEF. The secondary endpoint was assessing the predictors of LVEF recovery. Results Three-hundred eighty-two records were retrieved from the searched databases. After screening for eligibility criteria, 18 articles were chosen for qualitative synthesis and 15 articles were chosen for quantitative synthesis. All the prognostic measures including all-cause mortality, cardiovascular mortality, all-cause hospitalization, cardiovascular hospitalization and HF hospitalization were significantly lower in HFrecEF than HFrEF (RR= 0.58; 95% CI= 0.45-0.7, RR= 0.41; 95% CI= 0.29-0.58, RR= 0.75; 95% CI= 0.61-0.94, RR= 0.75; 95% CI= 0.73-0.78, RR, 0.56; 95% CI= 0.4-0.78 respectively) (Figures 1, 2, 3). The difference between HFrecEF and HFpEF patients regarding all-cause mortality was insignificant (Figure 1). Female gender, younger age, less severity of HF condition and lower rates of previous indications of CABG surgeries and defibrillator placements were associated with higher rates of LVEF recovery. Conclusion HFrecEF has a significantly different prognosis from HFrEF, which supports the hypothesis considering it a separate entity of heart failure types.