The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

Abstract

Background and aimsHeart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all‐cause mortality and HF hospitalizations associated with new‐onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF (adv. HF).MethodsWe performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30‐day and one‐year all‐cause mortality, as well as one‐year HF hospitalization. Studies were pooled using random effects meta‐analysis, and mixed‐effects meta‐regression was used to compare the different HF groups.ResultsAmong the 15.759 studies screened, 66 were included representing 862.046 HF patients. Pooled 30‐day mortality rates did not reveal a significant distinction between hospital‐admitted patients, with rates of 10.13% for new‐onset HF and 8.11% for WHF (p = 0.10). However, the one‐year mortality risk differed and increased stepwise from CHF to adv. HF, with a rate of 8.47% (95% CI 7.24–9.89) for CHF, 21.15% (95% CI 17.78–24.95) for new‐onset HF, 26.84% (95% CI 23.74–30.19) for WHF, and 29.74% (95% CI 24.15–36.10) for adv HF. Readmission rates for HF at one year followed a similar trend.ConclusionsOur meta‐analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards adv. HF.This article is protected by copyright. All rights reserved.

Worsening heart failure comes into focus, chronic heart failure takes a backseat

“…Patients in the new-onset HF and WHF cohorts included in this meta-analysis were older than patients in the other two categories. 4 However, the meta-regression approach showed that the risk differed across HF stages in spite of age adjustment (age adjusted odds of death 2.72 for new-onset HF, 3.58 for WHF and 5.15 for advanced HF). In contrast, women had a persistent higher mortality risk in comparison to men across all HF stages in the sex-specific subgroup sensitivity analysis.…”

“…The work by Shakoor et al 4 define WHF and new-onset HF. Of note, WHF patients received less frequently optimal medical therapy (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors) compared with CHF patients (74% vs. 96%), and had a similar percentage than those with advanced HF (74% vs. 78%).…”

“…After this meta-analysis, 4 which comprises 10 years of observational research summarized in 66 studies, the scientific community might wonder whether there is sufficient evidence to start heading towards a more phenotypic HF classification which would take into account not only aetiology and left ventricular ejection fraction (LVEF), but also other factors based on the chronology and the severity of the disease (i.e. HF stages).…”

“…Shakoor and colleagues 4 showed in four representative HF cohorts (nearly equivalent prevalence of ischaemic heart disease and female sex) that while mean LVEF was similar in the CHF and WHF groups (mean LVEF 37% vs. 38%), the WHF group had five-fold higher pooled mortality rates than CHF. Whilst these data have to be interpreted within its limitations, with particular emphasis on a potential ecological fallacy, it suggests that other markers may be as determinant as LVEF to indicate progression and an unfavourable prognosis.…”