Real-World Outcomes in Heart Failure With Reduced Ejection Fraction: A Middle Eastern Cohort Analysis

Abstract

Introduction: Till this day, heart failure with reduced ejection fraction (HFrEF) remains one of the greatest causes of morbidity and mortality worldwide. Despite the technological advances in diagnosis and therapy, we still witness extreme cases of deterioration and premature mortality. This has proven the importance of assessing the “Real-World Outcomes in Heart Failure with Reduced Ejection Fraction,” especially in the Middle East, where there is a lack of data previously collected. Through such efforts, we can aim to optimize management and improve patient outcomes.

Methods: We conducted a retrospective cohort study across multiple tertiary centers in the Middle East between January 2019 and December 2024. Adult patients admitted with HFrEF (left ventricular ejection fraction ≤40%) were identified through institutional registries. Demographics, comorbidities, and use of guideline-directed medical therapy (GDMT) were recorded. Patients were followed for a median of 30 months. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization. Multivariable Cox regression was performed to identify independent predictors.

Results: A total of 1,276 patients were included (mean age 62±12 years, 34% women). Hypertension (69%), diabetes mellitus (55%), and chronic kidney disease (26%) were the most common comorbidities. At discharge, 76% were prescribed β-blockers, 65% ACEI/ARB/ARNI, 52% mineralocorticoid receptor antagonists, and 28% SGLT2 inhibitors. Over follow-up, mortality occurred in 18% and rehospitalization in 29%. Predictors of adverse outcomes included advanced age (HR 1.36; 95% CI 1.13–1.63), chronic kidney disease (HR 1.58; 95% CI 1.26–1.99), and incomplete GDMT (HR 1.71; 95% CI 1.35–2.18). SGLT2 inhibitor use was associated with a significantly lower risk of rehospitalization (HR 0.68; 95% CI 0.52–0.89).

Conclusion: This large Middle Eastern cohort highlights substantial residual risk in patients with HFrEF, reflecting both comorbidity burden and suboptimal therapy utilization. Broader adoption of guideline-recommended therapies, particularly SGLT2 inhibitors, may reduce adverse outcomes and improve long-term prognosis.