{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:49:14Z","timestamp":1791542954303,"version":"4.3.4"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Anaemia is among the most prevalent comorbidities in heart failure with preserved ejection fraction (HFpEF), but pooled prognostic estimates predate the contemporary left ventricular ejection fraction (LVEF) \u226550% definition and combine legacy with contemporary cohorts. We quantified the association between World Health Organization (WHO)-defined anaemia and all-cause mortality in HFpEF and tested whether it persists under the stricter ejection-fraction threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Following PRISMA 2020 (PROSPERO CRD420251361160), we searched five databases from inception to 2026 and included cohort studies reporting an adjusted hazard ratio (aHR) for binary WHO-defined anaemia vs all-cause mortality in an ejection fraction-stratified HFpEF population; every estimate was verified against its primary source and screening was duplicated (\u03ba = 1.00 after adjudication). Of 6123 records, 20 studies were included; 17 (109 909 patients; anaemia prevalence 26%\u201370%; follow-up 12\u201372 months) contributed to two pre-specified co-primary pools analysed with Paule\u2013Mandel random-effects models and Hartung\u2013Knapp\u2013Sidik\u2013Jonkman variance correction: a legacy pool (LVEF \u226540%, k = 17) and a contemporary pool (LVEF \u226550%, k = 12). Anaemia was associated with higher all-cause mortality in both: aHR 1.49 (95% CI 1.35\u20131.66; 95% prediction interval (PI) 1.07\u20132.09; I2 = 85%) in the \u226540% pool and 1.41 (1.26\u20131.57; PI 1.06\u20131.87; I2 = 83%) in the \u226550% pool, both PIs excluding the null. The estimate was stable across 12 pre-specified sensitivity analyses (range 1.45\u20131.52) with no influential study. Across four Bayesian priors, the posterior median aHR was 1.39\u20131.49 with posterior probability of harm \u2265.999, and a robust Bayesian model-average that entertains null, homogeneity, and publication-bias models returned aHR 1.41 (95% credible interval 1.17\u20131.58). Although small-study effects were detected (Egger P = .03), the bias-corrected estimate was essentially unchanged (PEESE aHR 1.39). A per-1\u2005g\/dL lower-haemoglobin dose\u2013response meta-analysis (k = 6) yielded aHR 1.17 (1.08\u20131.27). The accrued sample exceeded the diversity-adjusted required information size, and GRADE certainty was moderate under the prognostic-factor framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>WHO-defined anaemia is independently associated with a \u223c40\u201350% higher all-cause mortality in HFpEF, preserved under the contemporary LVEF \u226550% definition and robust to extensive sensitivity, Bayesian, and bias-correction analyses. These findings support incorporating anaemia into HFpEF risk assessment and motivate mortality-powered trials in rigorously defined HFpEF, while not implying that anaemia correction improves outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO CRD420251361160.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag213","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:15:59Z","timestamp":1788520559000},"source":"Crossref","is-referenced-by-count":0,"title":["Anaemia and all-cause mortality in contemporary heart failure with preserved ejection fraction (left ventricular ejection fraction \u226550%): an updated systematic review and 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