Association of clonal haematopoiesis with heart failure incidence and outcomes: A systematic review and meta-analysis.

Aims

Clonal haematopoiesis (CH) is recognized as a significant risk factor for various non-haematologic conditions, including cardiovascular diseases. However, recent studies examining its relationship with heart failure (HF) have reported conflicting findings. To address these inconsistencies, the present meta-analysis aimed to evaluate the association of CH with the incidence and clinical outcomes of HF.

Methods and results

MEDLINE, Cochrane Library and Scopus were searched until 12 December 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using three-level mixed-effects meta-analyses. Participants (n = 57 755) with CH had significantly greater risk of new-onset HF compared to the non-CH group (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12-1.35, p < 0.0001; I2 = 0%), irrespective of a prior history of coronary artery disease. CH was also correlated with a higher risk of the composite outcome of all-cause mortality and hospitalization for HF (HHF) compared to the non-CH group in patients with established HF (HR 1.84, 95% CI 1.25-2.70, p = 0.002; I2 = 0%). Specifically, CH was associated with a 95% higher risk of all-cause mortality (HR 1.95, 95% CI 1.54-2.47, p < 0.0001; I2 = 0%), with a 3% increase in risk for every 1% increase in variant allele fraction. Participants with concomitant HF and CH had a 56% higher risk of HHF compared to non-CH HF patients (HR 1.56, 95% CI 1.05-2.33, p = 0.029; I2 = 19%).

Conclusion

Clonal haematopoiesis is associated with an increased risk of incident HF and worse prognosis in individuals affected by HF. These findings highlight the potential of CH to contribute to a deeper understanding of HF, improve risk stratification, and support more personalized approaches to its management.

© 2025 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.