AIM: The pharmacotherapy for heart failure with normal ejection fraction (HFNEF) is not as well defined as that for the treatment for heart failure with reduced ejection fraction (HFREF). Studies of the various drugs given for HFNEF have revealed conflicting results. The aim of this systematic review was to determine whether there is any benefit with pharmacotherapy in HFNEF in terms of cardiac outcomes. METHODS: Electronic and printed sources were searched until August 2010 for randomized controlled clinical trials (RCTs) comparing drug therapy with placebo in HFNEF. Weighted mean difference and pooled odds ratio (OR) with 95% confidence intervals were calculated. RESULTS: A total of six RCTs including 8410 patients with a mean follow-up period of 21 months were included in the analysis. Although there were no significant differences in all cause mortality between the two groups (pooled OR 0.95, 95% CI 0.79, 1.13, P= 0.55), the subgroup analysis revealed a slight but non significant advantage with the β-adrenoceptor blocker group. There was no significant difference between the two groups in terms of cardiovascular mortality, hospitalization, worsening heart failure, ejection fraction, E : A ratio, deceleration time and E : E' ratio. CONCLUSION: There was no significant benefit of pharmacotherapy in HFNEF. This might have been because of a lack of stringent inclusion criteria for patients in the trials and lower power of the studies. Hence trials with well defined inclusion criteria, better power, longer follow-up periods and with echocardiographic parameters as endpoints are required to shed further light on this topic.
AIM: The pharmacotherapy for heart failure with normal ejection fraction (HFNEF) is not as well defined as that for the treatment for heart failure with reduced ejection fraction (HFREF). Studies of the various drugs given for HFNEF have revealed conflicting results. The aim of this systematic review was to determine whether there is any benefit with pharmacotherapy in HFNEF in terms of cardiac outcomes. METHODS: Electronic and printed sources were searched until August 2010 for randomized controlled clinical trials (RCTs) comparing drug therapy with placebo in HFNEF. Weighted mean difference and pooled odds ratio (OR) with 95% confidence intervals were calculated. RESULTS: A total of six RCTs including 8410 patients with a mean follow-up period of 21 months were included in the analysis. Although there were no significant differences in all cause mortality between the two groups (pooled OR 0.95, 95% CI 0.79, 1.13, P= 0.55), the subgroup analysis revealed a slight but non significant advantage with the β-adrenoceptor blocker group. There was no significant difference between the two groups in terms of cardiovascular mortality, hospitalization, worsening heart failure, ejection fraction, E : A ratio, deceleration time and E : E' ratio. CONCLUSION: There was no significant benefit of pharmacotherapy in HFNEF. This might have been because of a lack of stringent inclusion criteria for patients in the trials and lower power of the studies. Hence trials with well defined inclusion criteria, better power, longer follow-up periods and with echocardiographic parameters as endpoints are required to shed further light on this topic.
Authors: Marcus D Flather; Marcelo C Shibata; Andrew J S Coats; Dirk J Van Veldhuisen; Aleksandr Parkhomenko; Joszef Borbola; Alain Cohen-Solal; Dan Dumitrascu; Roberto Ferrari; Philippe Lechat; Jordi Soler-Soler; Luigi Tavazzi; Lenka Spinarova; Jiri Toman; Michael Böhm; Stefan D Anker; Simon G Thompson; Philip A Poole-Wilson Journal: Eur Heart J Date: 2005-01-09 Impact factor: 29.983
Authors: M Senni; C M Tribouilloy; R J Rodeheffer; S J Jacobsen; J M Evans; K R Bailey; M M Redfield Journal: Circulation Date: 1998-11-24 Impact factor: 29.690
Authors: Salim Yusuf; Marc A Pfeffer; Karl Swedberg; Christopher B Granger; Peter Held; John J V McMurray; Eric L Michelson; Bertil Olofsson; Jan Ostergren Journal: Lancet Date: 2003-09-06 Impact factor: 79.321
Authors: Christopher B Granger; John J V McMurray; Salim Yusuf; Peter Held; Eric L Michelson; Bertil Olofsson; Jan Ostergren; Marc A Pfeffer; Karl Swedberg Journal: Lancet Date: 2003-09-06 Impact factor: 79.321
Authors: Margaret M Redfield; Steven J Jacobsen; John C Burnett; Douglas W Mahoney; Kent R Bailey; Richard J Rodeheffer Journal: JAMA Date: 2003-01-08 Impact factor: 56.272
Authors: Alain G Bertoni; W Gregory Hundley; Mark W Massing; Denise E Bonds; Gregory L Burke; David C Goff Journal: Diabetes Care Date: 2004-03 Impact factor: 19.112