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Luana Mendes dos Santos

 

Luana Mendes dos Santos

University of Sao Paulo,
Brazil

Abstract Title: Prognosis and survival of patients with heart failure with mid-range ejection fraction (HFmrEF) in a developing country: A comparative study with global data

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Background: Heart failure with mid-range ejection fraction (HFmrEF; LVEF 41–49%) remains an understudied entity, particularly in low- and middle-income countries. Global evidence suggests intermediate prognosis between HFrEF and HFpEF; however, regional variations may impact survival.

Objective: To assess the long-term survival of patients with HFmrEF in a Brazilian tertiary center and compare it to international cohorts.

Methods: We performed a retrospective cohort study including 83 patients diagnosed with HFmrEF between 2018 and 2023. Clinical, demographic, and etiological data were collected. Overall survival was estimated using Kaplan-Meier analysis. Results were compared with international studies identified via a structured literature review (PubMed, SciELO, LILACS). Cox regression was used to explore factors associated with mortality.

Results: The cohort had a mean age of 53 ± 12.5 years, with male predominance (73.5%). Hypertension was the leading etiology (37.5%), contrasting with ischemic causes reported in developed countries. The 5-year survival rate for HFmrEF was 55.4% (mean survival 3.87 years; 95% CI: 45.7%–67.2%), significantly lower than in global registries such as GWTG-HF (USA, ~70%) and CHARM (Europe, ~76%). Notably, Brazilian patients were younger than those in international studies (53 vs. 66–72 years). In contrast, patients with HFrEF in the same center had a higher survival rate (82.7%).

Conclusion: In this Brazilian cohort, HFmrEF patients exhibited a lower survival rate than those reported in high-income countries, despite being significantly younger. The predominance of hypertensive etiology, limited access to optimized therapy, and systemic healthcare disparities may contribute to this unfavorable prognosis. These findings underscore the need for tailored strategies to improve HF outcomes in resourceconstrained settings. Keywords: Heart failure, mid-range ejection fraction, survival, hypertension, risk factors.