Heart failure & cardiomyopathiesMeta-analysis
Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction
- Systematic review and network meta-analysis of randomised trials
- additive component 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))
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. JACC Heart Fail. Published 30 August 2023. doi:10.1016/j.jchf.2023.07.014
Summarised from the published abstract; every number is checked against it