Heart Failure and All-Cause Hospitalizations in Patients With Heart Failure: A Meta-Analysis.

Area of Science:

• Cardiology
• Clinical Trials
• Health Services Research

Background:

• Heart failure (HF) hospitalization is a key endpoint in HF clinical trials.
• The relationship between HF hospitalizations and all-cause hospitalizations, including reporting practices, remains understudied.

Purpose of the Study:

• To determine the ratio of HF to all-cause hospitalizations.
• To assess the correlation between treatment effects on HF hospitalization and all-cause hospitalization.
• To evaluate the frequency of reporting all-cause hospitalization alongside HF hospitalization in randomized clinical trials (RCTs).

Main Methods:

• A systematic search of PubMed for HF RCTs published in leading medical journals was conducted.
• Data extraction followed PRISMA guidelines, focusing on baseline characteristics and hospitalization outcomes.
• Hierarchical Bayesian models were used to evaluate the association between treatment effects on HF and all-cause hospitalizations.

Main Results:

• Of 113 trials (261,068 patients), 53.1% reported all-cause hospitalization.
• The weighted median ratio of HF to all-cause hospitalizations was 45.9%.
• Reported treatment effects on HF and all-cause hospitalizations were highly correlated (R²=90.1%), but substantial reductions in HF events were needed to infer reductions in all-cause events.

Conclusions:

• All-cause hospitalization is underreported in HF trials despite its significant burden.
• Clinically relevant reductions in all-cause hospitalizations cannot be inferred without large observed reductions in HF hospitalizations.
• This highlights a need for improved reporting standards in heart failure research.