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Metaanálisis de la red de calidad de vida en la insuficiencia cardíaca con fracción de eyección reducida
Robert Margaryan1, Nariman Sepehrvand1, Wouter Ouwerkerk2,3
1Canadian VIGOUR Centre, University of Alberta, Edmonton. (R.M., N.S., J.A.E.).
Circulation. Heart failure
|September 5, 2025
Resumen
La combinación de inhibidores del receptor de angiotensina/neprilisina (ARNi) con inhibidores beta (BB) y inhibidores de SGLT2 mejora significativamente la calidad de vida en pacientes con insuficiencia cardíaca con fracción de eyección reducida (HFrEF). Esta terapia combinada ofrece un enfoque prometedor para mejorar el bienestar del paciente en el manejo de HFrEF.
Área de la Ciencia:
- Cardiología
- Farmacología
- Ensayos clínicos
Sus antecedentes:
- El impacto en la calidad de vida de las farmacoterapias de insuficiencia cardíaca con fracción de eyección reducida (HFrEF) no ha sido evaluado.
- La investigación existente se centra en la mortalidad y la morbilidad, descuidando los resultados informados por los pacientes.
Objetivo del estudio:
- Evaluar y comparar el impacto compuesto de las terapias farmacológicas en la calidad de vida en HFrEF.
- Identificar las combinaciones de tratamiento óptimas para mejorar la calidad de vida de los pacientes con HFrEF.
Principales métodos:
- Metaanálisis de redes frecuentistas y revisión sistemática de ensayos controlados aleatorios (ECA).
- Buscado en MEDLINE, EMBASE y el Registro Central de Ensayos Controlados de Cochrane (2021-2024).
- Se incluyeron terapias HFrEF contemporáneas y eficaces; resultado primario: calidad de vida (cuestionario de miocardiopatía de Kansas City, cuestionario de vida con insuficiencia cardíaca de Minnesota).
Principales resultados:
- Se analizaron 41 ECA con 41.145 pacientes; fracción de eyección media del 28%, mediana de seguimiento de 5 meses.
- Los inhibidores del receptor de angiotensina/neprilisina (ARNi) + los inhibidores de la β (BB) + los inhibidores del cotransportador de sodio-glucosa 2 (SGLT2i) mostraron la mejoría más efectiva de la calidad de vida (MD, +5,3).
- Individualmente, los inhibidores de SGLT2 (MD, +3,4) y la ivabradina (MD, +3,3) fueron los más eficaces.
Conclusiones:
- La terapia compuesta de ARNi+BB+SGLT2i es la más efectiva para mejorar la calidad de vida en HFrEF.
- Las terapias combinadas que incluyen ARNi, BB y SGLT2i representan un avance significativo en la atención y el bienestar de los pacientes con HFrEF.
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