Patient-Centered Outcomes in Heart Failure Pharmacotherapy: A Meta-Analysis of Randomized Controlled Trials

Area of Science:

• Cardiology
• Pharmacology

Background:

• Guideline-directed medical therapy for heart failure (HF) reduces mortality and morbidity.
• The impact of HF pharmacotherapy on quality of life (QOL) and exercise capacity remains less understood.

Purpose of the Study:

• To quantify the benefits of HF pharmacotherapy on patient-centered outcomes, specifically QOL (Kansas City Cardiomyopathy Questionnaire [KCCQ] score) and exercise capacity (6-minute walking distance [6MWD]).
• To analyze the effects of various HF pharmacotherapies in ambulatory chronic HF patients.

Main Methods:

• Meta-analysis of randomized controlled trials in ambulatory HF settings.
• Intervention groups included intravenous (IV) iron, beta-blockers, SGLT2 inhibitors, ARNI, MRA, vericiguat, ivabradine, and GLP1 or GLP1/GIP agonists.
• Coprimary outcomes were KCCQ score for QOL and 6MWD for exercise capacity.

Main Results:

• IV iron, SGLT2 inhibitors, and GLP1 or GLP1/GIP agonists significantly improved KCCQ scores compared to placebo.
• GLP1 or GLP1/GIP agonists and IV iron significantly improved 6MWD compared to placebo.
• No significant differences in KCCQ or 6MWD were observed for MRA, ARNI, vericiguat, or ivabradine compared to placebo or active controls.

Conclusions:

• IV iron and GLP1 agonists or GLP1/GIP agonists demonstrated significant improvements in both QOL and exercise capacity in HF patients.
• SGLT2 inhibitors significantly improved QOL but did not show a significant effect on exercise capacity.