Prevalence of Pulmonary Hypertension in Individuals With Heart Failure: A Systematic Review and Meta-Analysis

Heart failure (HF) is a leading cause of hospitalizations worldwide. HF can lead to pulmonary hypertension (PH) and co-occurrence of HF and PH is associated with a poor prognosis. This systematic review and meta-analysis aim to estimate the prevalence of PH in patients with HF.

We searched MEDLINE and EMBASE for studies reporting the prevalence of PH amongst HF patients. A meta-analysis of PH prevalence, including subgroup analyses, was conducted using a random-effects model. Subgroup analyses and meta-regressions by comorbidities and patient characteristics were done. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool.

Fifty-four papers with 259 665 HF patients were included, of which 46 004 also had PH. The overall PH prevalence estimate in individuals with HF is 46.6% (95% CI: 39.6%-53.7%). Prevalence varied by diagnostic method, with studies using right heart catheterization reporting the highest estimates (62.5%; 52.0%-72.0%), hospital recorded data the lowest (18.4%; 14.4%-23.3%), and echocardiography 45.7% (37.1%-54.6%). Prevalence was higher in HF with preserved (47.2%; 34.8%-60.0%) than reduced ejection fraction (35.7%; 22.6%-51.3%). Prospective studies show higher estimates (60.1%; 50.7%-68.8%) than retrospective studies (37.3%; 29.5%-45.9%).

This is the first systematic review and meta-analysis investigating the prevalence of PH in HF patients and shows that the prevalence of PH in this patient population is strikingly high. There is notable variability in estimates reported by different studies, largely attributed to differences in the diagnostic method of PH. Future studies with robust, standardized methodologies are needed to estimate prevalence more accurately.