Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis

Xiang, Boyang; Yu, Zongliang; Zhou, Xiang

doi:10.3389/fcvm.2021.787810

Cited by 11 publications

(11 citation statements)

References 25 publications

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“…The threshold defining the concomitant therapy referred to published articles. 5 , 12 , 13 When more than 50% of patients in a trial received concomitant drugs, the intervention class was classified as a combined treatment (primary trial drug class plus concomitant drug class). If necessary, additional sensitivity analysis was performed.…”

Section: Methodsmentioning

confidence: 99%

“… 3 , 4 The incremental use of combinations of these drugs has contributed to progressive benefits for patients with HFrEF. 5 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 The incremental use of combinations of these drugs has contributed to progressive benefits for patients with HFrEF. 5 Nevertheless, the development of medical therapy for HF with higher ejection fraction has failed to meet expectations. Many large-scale clinical trials on ARNIs, MRAs, ACE inhibitors, ARBs, and β-blockers demonstrated neutral results in the primary composite outcome of death or HF hospitalization for patients with HFpEF and HFmrEF.…”

Section: Introductionmentioning

confidence: 99%

“…Sodium-glucose cotransporter 2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists (MRAs), angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and angiotensin receptor-neprilysin inhibitors (ARNIs) have been recommended as disease-modifying treatments for patients with HFrEF by US and European clinical guidelines . The incremental use of combinations of these drugs has contributed to progressive benefits for patients with HFrEF …”

Section: Introductionmentioning

confidence: 99%

“…Network meta-analysis is a reliable method to simultaneously compare multiple different interventions without head-to-head studies. In this article, we used a bayesian network meta-analysis to compare the outcomes associated with these HF treatment drugs for patients with HFpEF or HFmrEF and to explore whether the benefits associated with these drugs for patients with HF with higher ejection fraction were as accumulative as for patients with HFrEF …”

Section: Introductionmentioning

confidence: 99%

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Optimal Pharmacologic Treatment of Heart Failure With Preserved and Mildly Reduced Ejection Fraction

Xiang

Zhang

et al. 2022

JAMA Netw Open

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ImportanceIn recent years, significant progress has been made in the pharmacologic treatment of heart failure (HF) with reduced ejection fraction (HFrEF), but there is still insufficient evidence for drug therapy for HF with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF).ObjectiveTo compare the outcomes associated with different drug combinations for the treatment of HFpEF and HFmrEF.Data SourcesA search of the PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted for studies published from inception to October 9, 2021.Study SelectionRandomized clinical trials on the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs), β-blockers, and sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with HFpEF or HFmrEF.Data Extraction and SynthesisData extraction and bias assessment were independently performed by 2 reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. All data for 3 outcomes were pooled with a fixed-effect model.Main Outcomes and MeasuresThe main outcomes were first hospitalization for HF, all-cause mortality, and cardiovascular mortality. Hazard ratios (HRs) and 95% credible intervals (CrIs) were evaluated using a bayesian network meta-analysis model.ResultsIn this analysis, 19 randomized clinical trials, including 20 633 patients with HF and an ejection fraction of 40% or more, without a remarkable risk of bias were included. Compared with placebo, no treatments were associated with a significant reduction in the risk of all-cause death or cardiovascular death. SGLT2 inhibitors, ARNIs, and MRAs were associated with a significant decrease in the risk of HF hospitalization compared with placebo (SGLT2 inhibitors: HR, 0.71 [95% CrI, 0.60-0.83]; ARNIs: HR, 0.76 [95% CrI, 0.61-0.95]; MRAs: HR, 0.83 [95% CrI, 0.69-0.99]), and SGLT2 inhibitors were the optimal drug class in terms of reducing the risk for HF admission. Sensitivity analysis results demonstrated a progressive decrease in the risk of HF admission and an advance in mean rank associated with the increasing use of drug classes.Conclusions and RelevanceThe findings of this study suggest that SGLT2 inhibitors were the optimal drug class for HFpEF and HFmrEF, consistent with the most recent guideline recommendation. The incremental use of combinations of SGLT2 inhibitors, ACE inhibitors or ARBs, and β-blockers may be associated with accumulative benefits in HF hospitalization rather than all-cause death among patients with HFpEF and HFmrEF.

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Section: Methodsmentioning

confidence: 99%

“… 3 , 4 The incremental use of combinations of these drugs has contributed to progressive benefits for patients with HFrEF. 5 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal Pharmacologic Treatment of Heart Failure With Preserved and Mildly Reduced Ejection Fraction

Xiang

Zhang

et al. 2022

JAMA Netw Open

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Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

Man,

Klopotowska,

Asselbergs

et al. 2024

Curr Heart Fail Rep

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Purposeof Review Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. Recent Findings We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. Summary There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional’s workload.

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Letter to the editor: Heart failure with stable mildly reduced ejection fraction: Prognosis and predictors of outcomes

Sawlani,

Kumar,

Kumar

et al. 2024

Current Problems in Cardiology

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Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis

Cited by 11 publications

References 25 publications

Optimal Pharmacologic Treatment of Heart Failure With Preserved and Mildly Reduced Ejection Fraction

Optimal Pharmacologic Treatment of Heart Failure With Preserved and Mildly Reduced Ejection Fraction

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

Letter to the editor: Heart failure with stable mildly reduced ejection fraction: Prognosis and predictors of outcomes

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