Heart failure & cardiomyopathies
Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction: Systematic Review and Network Meta-Analysis
Authors' conclusion
In patients with HF and LVEF>40%, the quadruple combination of ARNI, BB, MRA, and SGLT2i provides the largest reduction in the risk of CV death and HHF; driven by the robust effect of the triple combination of ARNI, MRA, and SGLT2i. The benefit was more pronounced in HFmrEF patients.
Study context
- Population
- Patients with heart failure (HF) and left ventricular ejection fraction (LVEF) >40% (heart failure with mildly reduced ejection fraction (HFmrEF) and HFpEF); mean LVEF 56.3% ± 8.7%
- Participants
- 29,875 patients · 13 studies
- Comparison
- Angiotensin receptor neprilysin inhibitor (ARNI), MRA, SGLT2i, RASi, beta-blockers, digoxin and their combinations vs placebo
- Outcome
- Composite of:
- CV death
- First hospitalization for HF (hospitalization for heart failure (HHF))
Methodological detailsadditive component network meta-analysis
- Additive component network meta-analysis
Pooled result
As reported in the abstract
CV death or first HHF
Hazard ratio (95% CI)
ARNI + BB + MRA + SGLT2i vs Placebomost effective
0.47(0.31–0.70)
ARNI + MRA + SGLT2i vs Placebo
0.56(0.43–0.71)
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| CV death | 0.63 (0.43–0.91) | |
| Total HHF | 0.49 (0.33–0.71) | |
| 0.20.5125Hazard ratio (log scale) |
Primary outcome by LVEF subgroup
- Only SGLT2i had a consistent benefit among all LVEF subgroups
- Triple combination: greatest benefit in HFmrEF, robust benefit at LVEF 50% to 59%, statistically marginal benefit at LVEF ≥60%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction: Systematic Review and Network Meta-Analysis. JACC Heart Fail. Published 30 August 2023. doi:10.
Summarised from the published abstract; every number is checked against it