Heart failure & cardiomyopathies
The Impact of Heart Failure Therapy in Patients with Mildly Reduced Ejection Fraction: A Network Meta-Analysis
Authors' conclusion
In addition to SGLT2i, pharmacological treatment recommended for HF with reduced LVEF, namely, ARNi, MRA, and BB, can also be effective in HFmrEF. This NMA did not show significant superiority over any pharmacological class.
Study context
- Population
- Heart failure (HF) with mildly reduced EF (left ventricular ejection fraction (LVEF) 41%–49%)Six randomized controlled trials (RCTs), a pooled analysis of two RCTs and eleven beta-blockers (BB) RCTs
- Participants
- 7,966 participants
- Comparison
- Mineralocorticoid receptor antagonists (MRA), ARNI, angiotensin receptor blockers (ARB), angiotensin-converting-enzyme inhibitors (ACEi), SGLT2 inhibitors and beta-blockers vs placebo and each other
- Outcome
- Cardiovascular (CV) death or HF hospitalisation
Methodological detailsrandom-effects
- Random-effects
Pooled result
As reported in the abstract
Hazard ratio (95% CI)
SGLT2i vs Placeboonly significant comparison
0.81(0.67–0.98)
ARNi vs BB
0.81(0.47–1.41)
ARNi vs MRA
0.94(0.53–1.66)
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| HF hospitalisationARNi vs Placebo | 0.60 (0.39–0.92) | |
| HF hospitalisationSGLT2i vs Placebo | 0.74 (0.59–0.93) | |
| HF hospitalisationRASi (ARB and ACEi) vs Placebo | 0.72 (0.53–0.98) | |
| HF hospitalisationARNi vs RASi (ARB and ACEi) | 0.83 (0.62–1.11) | |
| HF hospitalisationARNi vs SGLT2i | 0.80 (0.50–1.30) | |
| CV deathBB vs Placebo · only class reducing CV death | 0.48 (0.24–0.95) | |
| 0.20.5125Hazard ratio (log scale) |
Comparisons between active treatments
- No statistically significant difference in any comparison between active treatments
Original publication
The Impact of Heart Failure Therapy in Patients with Mildly Reduced Ejection Fraction: A Network Meta-Analysis. ESC Heart Fail. Published 10 March 2023. doi:10.
Summarised from the published abstract; every number is checked against it