Heart failure & cardiomyopathies
Anaemia and all-cause mortality in contemporary heart failure with preserved ejection fraction (left ventricular ejection fraction ≥50%): an updated systematic review and meta-analysis
Authors' conclusion
WHO-defined anaemia is independently associated with a ∼40-50% higher all-cause mortality in HFpEF, preserved under the contemporary LVEF ≥50% definition and robust to extensive sensitivity, Bayesian, and bias-correction analyses. These findings support incorporating anaemia into HFpEF risk assessment and motivate mortality-powered trials in rigorously defined HFpEF, while not implying that anaemia correction improves outcomes.
Study context
- Population
- Patients with heart failure with preserved ejection fraction (HFpEF) in cohort studies reporting an adjusted hazard ratio for binary World Health Organization (WHO)-defined anaemia vs all-cause mortality17 studies contributing to the co-primary pools (20 studies included of 6123 records) · legacy pool (left ventricular ejection fraction (LVEF) ≥40%), studies k = 17 · contemporary pool (LVEF ≥50%), studies k = 12
- Participants
- 109,909 patients patients
- Comparison
- Binary WHO-defined anaemia vs all-cause mortality in an ejection fraction-stratified HFpEF population
- Outcome
- All-cause mortality (two pre-specified co-primary pools)
- Follow-up
- 12-72 months
Methodological detailsupdated, PRISMA 2020, Paule-Mandel random-effects models, Hartung-Knapp-Sidik-Jonkman variance correction
- Updated
- PRISMA 2020
- Paule-Mandel random-effects models
- Hartung-Knapp-Sidik-Jonkman variance correction
Pooled result
As reported in the abstract
Further pooled results
All-cause mortality, pre-specified sensitivity analyses
- Estimate range across 12 pre-specified sensitivity analyses
- 1.45-1.52
- No influential study
All-cause mortality, Bayesian analyses
- Posterior median aHR across four Bayesian priors
- 1.39-1.49
- Posterior probability of harm
- ≥.999
- Robust Bayesian model-average aHR
- 1.41 (95% credible interval 1.17-1.58)
Small-study effects
- Egger P
- P = 0.03
- PEESE aHR
- 1.39
- Bias-corrected estimate essentially unchanged
Per-1 g/dL lower-haemoglobin dose-response (k = 6)
- aHR per 1 g/dL lower haemoglobin
- 1.17 (1.08-1.27)
Information size and certainty
- Accrued sample exceeded the diversity-adjusted required information size
- GRADE certainty moderate under the prognostic-factor framework
Anaemia prevalence
- Anaemia prevalence
- 26%-70%
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →