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Heart failure

Robert Samuel McKelvie1

  • 1McMaster University, Hamilton, ON, Canada.

BMJ Clinical Evidence
|May 21, 2009
PubMed

Insights

This systematic review evaluates various heart failure treatments, including drugs, non-drug therapies, and invasive procedures. It provides evidence on the effectiveness and safety of interventions for improving patient outcomes and reducing mortality.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Evidence-Based Practice

Background:

  • Heart failure affects 3-4% of adults over 65, often stemming from coronary artery disease or hypertension.
  • It leads to breathlessness, reduced exercise tolerance, fluid retention, and elevated mortality rates.
  • Systolic heart failure carries a 5-year mortality of 25-75%, with ventricular arrhythmia a common cause of sudden death.

Purpose of the Study:

  • To systematically review the effects of drug, non-drug, and invasive treatments for heart failure.
  • To assess the impact of angiotensin-converting enzyme inhibitors in high-risk individuals.
  • To evaluate treatments specifically for diastolic heart failure.

Main Methods:

  • Conducted a systematic literature review up to January 2007.
  • Searched major databases including Medline, Embase, and The Cochrane Library.
  • Included harms alerts from regulatory agencies like the FDA and MHRA.

Main Results:

  • Identified 72 systematic reviews, RCTs, and observational studies meeting inclusion criteria.
  • Performed a GRADE evaluation to assess the quality of evidence for various interventions.
  • Synthesized information on the effectiveness and safety of numerous treatments.

Conclusions:

  • The review details the effectiveness and safety of interventions such as ACE inhibitors, ARBs, beta-blockers, and cardiac resynchronisation therapy.
  • It also covers anticoagulation, antiplatelet agents, implantable cardiac defibrillators, and multidisciplinary interventions.
  • Information on specific drugs like amiodarone, digoxin, and spironolactone is presented, alongside non-drug options like exercise.
Abstract

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