Dr. Jasper Tromp works as a physician, epidemiologist, and assistant professor of public health at the National University of Singapore and Duke-NUS Medical School in the epidemiology area. In this podcast Dr. Tromp discusses a Systematic Review and Network-Meta-Analysis of Pharmacological Treatment of Heart Failure With Reduced Ejection Fraction.
The goal of this study was to calculate and compare the total treatment benefit of pharmacological therapy for heart failure (HF) with a low ejection fraction.
The treatment effects of various combinations of modern HF medical therapy are not fully understood.
We conducted a systematic network meta-analysis for randomized controlled trials published between January 1987 and January 2020, using MEDLINE/EMBASE and the Cochrane Central Register of Controlled Trials. Digoxin, hydralazine-isosorbide dinitrate, ivabradine, angiotensin receptor–neprilysin inhibitors (ARNi), sodium glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv-mecarbil were among the drugs studied. The most common outcome was death from any cause. We calculated the number of life years gained in two HF groups (BIOSTAT-CHF [BIOlogy Study to TAilored Treatment in Chronic Heart Failure] and ASIAN-HF [Asian Sudden Cardiac Death in Heart Failure Registry]).
We found 75 trials with 95,444 participants that were relevant. All-cause death was reduced the most with a combination of ARNi, BB, MRA, and SGLT2i (HR: 0.39; 95 percent CI: 0.31-0.49); followed by ARNi, BB, MRA, and vericiguat (HR: 0.41; 95 percent CI: 0.32-0.53); and ARNi, BB, and MRA (HR: 0.41; 95 percent CI: 0.32-0.53). (HR: 0.44; 95 percent CI: 0.36-0.54). The composite outcome of cardiovascular death or initial hospitalization for HF had similar results (HR: 0.36; 95 percent CI: 0.29-0.46 for ARNi, BB, MRA, and SGLT2i; HR: 0.44; 95 percent CI: 0.35-0.56 for ARNi, BB, MRA, and omecamtiv-mecarbil; and HR: 0.43; 95 percent CI: 0.34-0.55 for ARNi, BB, MRA, and vericiguat). In secondary analyses, the projected increased number of life-years gained for a 70-year-old patient on ARNi, BB, MRA, and SGLT2i compared to no treatment was 5.0 years (2.5-7.5 years).
The anticipated aggregate benefit for a combination of ARNi, BB, MRA, and SGLT2i in patients with HF with reduced ejection fraction is the largest.