Heart failure & cardiomyopathies
Outcomes of heart failure with reduced, mildly reduced, or preserved ejection fraction: the European Society of Cardiology (ESC) Heart Failure (HF) III registry
Authors' conclusion
In HF in Europe and affiliated countries, in-hospital mortality was 5.1% and greater with lower ejection fraction. Among hospital survivors and out-patients over 1 year of follow-up, event rates per 100 patient-years varied for death, 3.9-22, CV death 1.7-13, and unknown cause of death 0.8-6.3. The percent of patients that were (re-)hospitalized for HF at least once over 1-year follow-up ranged 14-44% and was twice as high post-AHF compared with post-out-patient visit.
Study context
- Population
- Patients with HF in European or ESC affiliated countries, ESC HF III Registry, 2018–202039% AHF, 61% out-patient HF
- Participants
- 10,162 patients
- Exposure
- HF with Reduced Ejection Fraction (HFrEF) vs HF with Mildly Reduced Ejection Fraction (HFmrEF) vs HF with Preserved Ejection Fraction (HFpEF), in AHF and out-patient HF
- Outcome
- In-hospital and cause-specific (all-cause, CV, unknown-cause) mortality
- Follow-up
- 1 year
Methodological detailsmulticentre, 220 centres in 41 countries
- Multicentre
- 220 centres in 41 countries
Main finding
As reported in the abstract
Mortality per 100 patient-years (all-cause, CV, unknown cause) · median follow-up 376 (360-432) days
| Group | All-cause | Cardiovascular (CV) | Unknown cause |
|---|---|---|---|
| AHF HFrEF | 19 | 13 | 3.0 |
| AHF HFmrEF | 22 | 11 | 6.3 |
| AHF HFpEF | 16 | 7.0 | 4.7 |
| Out-patient HFrEF | 6.6 | 4.3 | 0.9 |
| Out-patient HFmrEF | 4.0 | 2.6 | 0.8 |
| Out-patient HFpEF | 3.9 | 1.7 | 1.2 |
All-cause
AHF HFrEF19
AHF HFmrEF22
AHF HFpEF16
Out-patient HFrEF6.6
Out-patient HFmrEF4.0
Out-patient HFpEF3.9
Cardiovascular (CV)
AHF HFrEF13
AHF HFmrEF11
AHF HFpEF7.0
Out-patient HFrEF4.3
Out-patient HFmrEF2.6
Out-patient HFpEF1.7
Unknown cause
AHF HFrEF3.0
AHF HFmrEF6.3
AHF HFpEF4.7
Out-patient HFrEF0.9
Out-patient HFmrEF0.8
Out-patient HFpEF1.2
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| In-hospital mortality (AHF) | AHF HFrEF 5.2% · AHF HFmrEF 4.8% · AHF HFpEF 3.4% |
| ≥1 (re-)hospitalization for HF · 1 year | AHF HFrEF 44% · AHF HFmrEF 42% · AHF HFpEF 36% · out-patient HFrEF 21% · out-patient HFmrEF 14% · out-patient HFpEF 18% |
| Duration of hospitalization (AHF) | AHF median 9 (IQR 6–14) days |
- In-hospital mortality (AHF) — Overall AHF in-hospital mortality
- 5.1%
Original publication
Outcomes of heart failure with reduced, mildly reduced, or preserved ejection fraction: the ESC HF III registry. Eur Heart J. Published 25 February 2026. doi:10.
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