Jasper Tromp1, Wouter Ouwerkerk2, Dirk J van Veldhuisen3, Hans L Hillege3, A Mark Richards4, Peter van der Meer3, Inder S Anand5, Carolyn S P Lam6, Adriaan A Voors7. 1. University Medical Centre Groningen, Department of Cardiology, University of Groningen, the Netherlands; Saw Swee Hock School of Public Health and National University of Singapore and National University Health System, Singapore; Duke-NUS Medical School Singapore, Singapore. Electronic address: https://twitter.com/drjasper01. 2. Saw Swee Hock School of Public Health and National University of Singapore and National University Health System, Singapore; Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands. 3. University Medical Centre Groningen, Department of Cardiology, University of Groningen, the Netherlands. 4. Cardiovascular Research Institute, Yong Loo-Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, Singapore; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand. 5. Veterans Affairs Medical Center, Minneapolis, Minnesota, USA. 6. University Medical Centre Groningen, Department of Cardiology, University of Groningen, the Netherlands; Saw Swee Hock School of Public Health and National University of Singapore and National University Health System, Singapore; Duke-NUS Medical School Singapore, Singapore. Electronic address: Carolyn.lam@duke-nus.edu.sg. 7. University Medical Centre Groningen, Department of Cardiology, University of Groningen, the Netherlands. Electronic address: A.A.Voors@umcg.nl.
Abstract
OBJECTIVES: This study sought to estimate and compare the aggregate treatment benefit of pharmacological therapy for heart failure (HF) with reduced ejection fraction. BACKGROUND: The estimated treatment effects of various combinations of contemporary HF medical therapies are not well characterized. METHODS: We performed a systematic network meta-analysis, using MEDLINE/EMBASE and the Cochrane Central Register of Controlled Trials for randomized controlled trials published between January 1987 and January 2020. We included angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers (BB), mineralocorticoid receptor antagonists (MRAs), digoxin, hydralazine-isosorbide dinitrate, ivabradine, angiotensin receptor-neprilysin inhibitors (ARNi), sodium glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv-mecarbil. The primary outcome was all-cause death. We estimated the life-years gained in 2 HF populations (BIOSTAT-CHF [BIOlogy Study to TAilored Treatment in Chronic Heart Failure] and ASIAN-HF [Asian Sudden Cardiac Death in Heart Failure Registry]). RESULTS: We identified 75 relevant trials representing 95,444 participants. A combination of ARNi, BB, MRA, and SGLT2i was most effective in reducing all-cause death (HR: 0.39; 95% CI: 0.31-0.49); followed by ARNi, BB, MRA, and vericiguat (HR: 0.41; 95% CI: 0.32-0.53); and ARNi, BB, and MRA (HR: 0.44; 95% CI: 0.36-0.54). Results were similar for the composite outcome of cardiovascular death or first hospitalization for HF (HR: 0.36; 95% CI: 0.29-0.46 for ARNi, BB, MRA, and SGLT2i; HR: 0.44; 95% CI: 0.35-0.56 for ARNi, BB, MRA, and omecamtiv-mecarbil; and HR: 0.43; 95% CI: 0.34-0.55 for ARNi, BB, MRA, and vericiguat). The estimated additional number of life-years gained for a 70-year-old patient on ARNi, BB, MRA, and SGLT2i was 5.0 years (2.5-7.5 years) compared with no treatment in secondary analyses. CONCLUSIONS: In patients with HF with reduced ejection fraction, the estimated aggregate benefit is greatest for a combination of ARNi, BB, MRA, and SGLT2i.
OBJECTIVES: This study sought to estimate and compare the aggregate treatment benefit of pharmacological therapy for heart failure (HF) with reduced ejection fraction. BACKGROUND: The estimated treatment effects of various combinations of contemporary HF medical therapies are not well characterized. METHODS: We performed a systematic network meta-analysis, using MEDLINE/EMBASE and the Cochrane Central Register of Controlled Trials for randomized controlled trials published between January 1987 and January 2020. We included angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers (BB), mineralocorticoid receptor antagonists (MRAs), digoxin, hydralazine-isosorbide dinitrate, ivabradine, angiotensin receptor-neprilysin inhibitors (ARNi), sodium glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv-mecarbil. The primary outcome was all-cause death. We estimated the life-years gained in 2 HF populations (BIOSTAT-CHF [BIOlogy Study to TAilored Treatment in Chronic Heart Failure] and ASIAN-HF [Asian Sudden Cardiac Death in Heart Failure Registry]). RESULTS: We identified 75 relevant trials representing 95,444 participants. A combination of ARNi, BB, MRA, and SGLT2i was most effective in reducing all-cause death (HR: 0.39; 95% CI: 0.31-0.49); followed by ARNi, BB, MRA, and vericiguat (HR: 0.41; 95% CI: 0.32-0.53); and ARNi, BB, and MRA (HR: 0.44; 95% CI: 0.36-0.54). Results were similar for the composite outcome of cardiovascular death or first hospitalization for HF (HR: 0.36; 95% CI: 0.29-0.46 for ARNi, BB, MRA, and SGLT2i; HR: 0.44; 95% CI: 0.35-0.56 for ARNi, BB, MRA, and omecamtiv-mecarbil; and HR: 0.43; 95% CI: 0.34-0.55 for ARNi, BB, MRA, and vericiguat). The estimated additional number of life-years gained for a 70-year-old patient on ARNi, BB, MRA, and SGLT2i was 5.0 years (2.5-7.5 years) compared with no treatment in secondary analyses. CONCLUSIONS: In patients with HF with reduced ejection fraction, the estimated aggregate benefit is greatest for a combination of ARNi, BB, MRA, and SGLT2i.
Authors: Pietro Scicchitano; Massimo Iacoviello; Francesco Massari; Micaela De Palo; Pasquale Caldarola; Antonia Mannarini; Andrea Passantino; Marco Matteo Ciccone; Michele Magnesa Journal: Biomedicines Date: 2022-07-16
Authors: Audrey Huili Lim; Nusaibah Abdul Rahim; Jinxin Zhao; S Y Amy Cheung; Yu-Wei Lin Journal: Front Pharmacol Date: 2022-09-05 Impact factor: 5.988
Authors: María Ascensión Sanromán Guerrero; Sonia Antoñana Ugalde; Elena Hernández Sánchez; Susana Del Prado Díaz; Marta Jiménez-Blanco Bravo; David Cordero Pereda; José Luis Zamorano Gómez; Jesús Álvarez-García Journal: Front Cardiovasc Med Date: 2022-07-25