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Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis
Jayakumar Sreenivasan1, Aaqib Malik1, Muhammad Shahzeb Khan2,3
1From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.
Cardiology in Review
|December 28, 2022
Summary
This study found no significant difference in mortality for heart failure with preserved ejection fraction (HFpEF) patients using various medications. However, sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin receptor-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA) reduced HF hospitalizations.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Heart failure with preserved ejection fraction (HFpEF) has multiple treatment options with unclear comparative effectiveness.
- Evaluating pharmacotherapies for HFpEF is crucial for optimizing patient outcomes.
Approach:
- A systematic search of EMBASE, Medline, and Cochrane Library was conducted for randomized clinical trials (RCTs) in HFpEF (ejection fraction >40%).
- Network meta-analysis assessed beta-blockers, MRA, ACE, ARB, ARNI, and SGLT2i for cardiovascular mortality, all-cause mortality, and HF hospitalization.
- 22 RCTs with 30,673 participants were included, with a median follow-up of 24.4 months.
Key Points:
- No significant differences in cardiovascular or all-cause mortality were observed for beta-blockers, MRA, ACE, ARB, ARNI, or SGLT2i compared to placebo.
- The certainty of evidence for mortality outcomes was low to very low.
- SGLT2i, ARNI, and MRA significantly reduced HF hospitalizations (moderate to low certainty).
Conclusions:
- Current evidence suggests that beta-blockers, MRA, ACE/ARB/ARNI, and SGLT2i do not improve mortality in HFpEF.
- SGLT2i, ARNI, and MRA demonstrate a benefit in reducing HF hospitalizations, offering a potential therapeutic advantage.
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