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The most effective combination of pharmacological therapy for heart failure with reduced ejection fraction: a network meta-analysis of randomized controlled trials.
- Source :
-
BMC cardiovascular disorders [BMC Cardiovasc Disord] 2024 Nov 23; Vol. 24 (1), pp. 666. Date of Electronic Publication: 2024 Nov 23. - Publication Year :
- 2024
-
Abstract
- Background: Evidence for the efficacy of pharmacological therapies for heart failure with reduced ejection fraction (HFrEF) is growing. However, there is no consensus on the most effective treatment for HFrEF. This study aimed to evaluate the most effective combination of pharmacological therapy in patients with HFrEF.<br />Methods: We systematically searched Medline, Embase, and CENTRAL up to Feb 2022, to include randomized controlled trials (RCTs) that evaluated the efficacy of pharmacological treatment among adults (≥ 18 years) with a diagnosis of HFrEF (defined by a left ventricular ejection fraction ≤ 45%). The outcomes of interest included all-cause death, cardiovascular (CV) death, and hospitalization for heart failure (HHF). A random network meta-analysis using a frequentist framework model was employed to calculate the pooled risk ratio (RR) with 95% confidence interval (CI) and rank the treatments.<br />Results: We included 49 RCTs involving 90,529 participants with HFrEF. For reducing all-cause mortality, the combination of angiotensin-converting enzyme inhibitors (ACEI), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose co-transporter-2 inhibitors (SGLT2i) was most effective (RR, 0.46; 95% CI, 0.32-0.66). For CV death, the combination of ACEI, BB, MRA, and Vericiguat showed the highest efficacy (RR, 0.34; 95% CI, 0.12-0.90). Regarding reducing HHF, the combination of ACEI, BB, MRA, and SGLT2i as well as the combination of ACEI, BB, MRA, and Ivabradine were equally the most effective (both RR, 0.27; 95% CI, 0.18-0.39).<br />Conclusion: This study provides robust evidence supporting the use of combination therapies in HFrEF management, with newer agents offering incremental benefits when added to established guideline-directed medical therapy.<br />Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.<br /> (© 2024. The Author(s).)
- Subjects :
- Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Cardiovascular Agents therapeutic use
Cardiovascular Agents adverse effects
Cause of Death
Mineralocorticoid Receptor Antagonists therapeutic use
Recovery of Function
Risk Factors
Sodium-Glucose Transporter 2 Inhibitors therapeutic use
Treatment Outcome
Drug Therapy, Combination
Heart Failure drug therapy
Heart Failure physiopathology
Heart Failure mortality
Heart Failure diagnosis
Network Meta-Analysis
Randomized Controlled Trials as Topic
Stroke Volume drug effects
Ventricular Function, Left drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2261
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cardiovascular disorders
- Publication Type :
- Academic Journal
- Accession number :
- 39578732
- Full Text :
- https://doi.org/10.1186/s12872-024-04339-3