Michel Komajda1, Michael Böhm2, Jeffrey S Borer3, Ian Ford4, Luigi Tavazzi5, Matthieu Pannaux6, Karl Swedberg7. 1. Department of Cardiology, Saint Joseph Hospital, Paris, France. 2. Universitätsklinikum des Saarlandes, Universität des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany. 3. Howard Gilman and Schiavone Institutes, State University of New York Downstate Medical Center, Brooklyn and New York, NY, USA. 4. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK. 5. Maria Cecilia Hospital-GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy. 6. Institut de Recherches Internationales Servier, Suresnes, France. 7. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden, and National Heart and Lung Institute, Imperial College, London, UK.
Abstract
AIMS: A network meta-analysis (NMA) of all recommended drug groups for the treatment of heart failure with reduced ejection fraction (HFrEF), including their combinations, was performed to assess the relative efficacy and incremental benefit. METHODS AND RESULTS: A search was made in biomedical databases for randomized controlled trials published between 1987 and 2017 on angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers (BBs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), ivabradine (IVA), or angiotensin receptor-neprilysin inhibitors (ARNI). A total of 58 relevant trials were identified. The relative efficacy of each treatment group (or combination) in terms of all-cause mortality, cardiovascular mortality, all-cause hospitalizations and hospitalizations for heart failure, per patient-year of follow-up, were combined in a random-effects Bayesian NMA. The pairwise comparison between each regimen and for each outcome was estimated. The NMA was dominated by 15 large-scale trials with between 1984 and 18 898 patient-years of follow-up. Combinations of drug groups showed incremental benefits on outcomes over single groups. The most effective combinations were ARNI+BB + MRA and ACEI+BB + MRA + IVA, showing reductions in all-cause mortality (vs. placebo) of 62% and 59%, respectively; hazard ratios were 0.38 [credible interval (CrI) 0.20-0.65] and 0.41 (CrI 0.21-0.70); and in all-cause hospitalizations with reductions of 42% for both. These two combinations were also the most effective for the other outcomes studied. CONCLUSION: Our analysis shows that the incremental use of combinations of disease-modifying therapies has resulted in the progressive improvement in mortality and hospitalization outcomes in HFrEF. Our findings support the current guideline recommendations.
AIMS: A network meta-analysis (NMA) of all recommended drug groups for the treatment of heart failure with reduced ejection fraction (HFrEF), including their combinations, was performed to assess the relative efficacy and incremental benefit. METHODS AND RESULTS: A search was made in biomedical databases for randomized controlled trials published between 1987 and 2017 on angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers (BBs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), ivabradine (IVA), or angiotensin receptor-neprilysin inhibitors (ARNI). A total of 58 relevant trials were identified. The relative efficacy of each treatment group (or combination) in terms of all-cause mortality, cardiovascular mortality, all-cause hospitalizations and hospitalizations for heart failure, per patient-year of follow-up, were combined in a random-effects Bayesian NMA. The pairwise comparison between each regimen and for each outcome was estimated. The NMA was dominated by 15 large-scale trials with between 1984 and 18 898 patient-years of follow-up. Combinations of drug groups showed incremental benefits on outcomes over single groups. The most effective combinations were ARNI+BB + MRA and ACEI+BB + MRA + IVA, showing reductions in all-cause mortality (vs. placebo) of 62% and 59%, respectively; hazard ratios were 0.38 [credible interval (CrI) 0.20-0.65] and 0.41 (CrI 0.21-0.70); and in all-cause hospitalizations with reductions of 42% for both. These two combinations were also the most effective for the other outcomes studied. CONCLUSION: Our analysis shows that the incremental use of combinations of disease-modifying therapies has resulted in the progressive improvement in mortality and hospitalization outcomes in HFrEF. Our findings support the current guideline recommendations.
Authors: Amr Abdin; Johann Bauersachs; Norbert Frey; Ingrid Kindermann; Andreas Link; Nikolaus Marx; Mitja Lainscak; Jonathan Slawik; Christian Werner; Jan Wintrich; Michael Böhm Journal: Clin Res Cardiol Date: 2021-05-13 Impact factor: 5.460
Authors: Daniela Tomasoni; Julie K K Vishram-Nielsen; Matteo Pagnesi; Marianna Adamo; Carlo Mario Lombardi; Finn Gustafsson; Marco Metra Journal: ESC Heart Fail Date: 2022-03-30