Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis
Background: The medical treatments of chronic heart failure have made remarkable progress in recent years. It is crucial to determine the optimal drug combination based on current evidence.Methods: A search of PubMed, EMBASE, and Cochrane CENTRAL databases was conducted for studies on angiotensin re...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.787810/full |
| _version_ | 1798021287312883712 |
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| author | Boyang Xiang Zongliang Yu Xiang Zhou |
| author_facet | Boyang Xiang Zongliang Yu Xiang Zhou |
| author_sort | Boyang Xiang |
| collection | DOAJ |
| description | Background: The medical treatments of chronic heart failure have made remarkable progress in recent years. It is crucial to determine the optimal drug combination based on current evidence.Methods: A search of PubMed, EMBASE, and Cochrane CENTRAL databases was conducted for studies on angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and ivabradine (IVA) between 1987 and 2021. The network meta-analysis was performed to compare the efficacy of drug therapies in heart failure with reduced ejection fraction (HFrEF).Results: Forty-eight randomized controlled trials (RCTs), which overall included 68,074 patients with HF and left ventricular ejection fraction (LVEF) ≤ 40%, were identified and included in the network meta-analysis. The efficacies of 13 intervention classes, including monotherapies or combinations of ACEI, ARB, ARNI, BB, MRA, SGLT2i, IVA, and placebo, on hospitalization for HF, cardiovascular mortality, and all-cause mortality were compared. Among the 13 included interventions, ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were found to be best in terms of all three outcomes. Compared with placebo, these three drug combinations were associated with significant reductions in the risk of all-cause death, cardiovascular mortality and hospitalization for HF.Conclusions: ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were the top three therapies for patients with HFrEF. The increasing use of combinations of conventional and novel drugs contributed to progressive reductions in hospitalization and mortality in patients with HFrEF. |
| first_indexed | 2024-04-11T17:11:14Z |
| format | Article |
| id | doaj.art-4247b1e755b043d6bf0ecc115ac60c53 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T17:11:14Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-4247b1e755b043d6bf0ecc115ac60c532022-12-22T04:12:54ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-01-01810.3389/fcvm.2021.787810787810Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-AnalysisBoyang Xiang0Zongliang Yu1Xiang Zhou2Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Cardiology, The First People's Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, ChinaDepartment of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, ChinaBackground: The medical treatments of chronic heart failure have made remarkable progress in recent years. It is crucial to determine the optimal drug combination based on current evidence.Methods: A search of PubMed, EMBASE, and Cochrane CENTRAL databases was conducted for studies on angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and ivabradine (IVA) between 1987 and 2021. The network meta-analysis was performed to compare the efficacy of drug therapies in heart failure with reduced ejection fraction (HFrEF).Results: Forty-eight randomized controlled trials (RCTs), which overall included 68,074 patients with HF and left ventricular ejection fraction (LVEF) ≤ 40%, were identified and included in the network meta-analysis. The efficacies of 13 intervention classes, including monotherapies or combinations of ACEI, ARB, ARNI, BB, MRA, SGLT2i, IVA, and placebo, on hospitalization for HF, cardiovascular mortality, and all-cause mortality were compared. Among the 13 included interventions, ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were found to be best in terms of all three outcomes. Compared with placebo, these three drug combinations were associated with significant reductions in the risk of all-cause death, cardiovascular mortality and hospitalization for HF.Conclusions: ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were the top three therapies for patients with HFrEF. The increasing use of combinations of conventional and novel drugs contributed to progressive reductions in hospitalization and mortality in patients with HFrEF.https://www.frontiersin.org/articles/10.3389/fcvm.2021.787810/fullchronic heart failuremedical treatmentmeta-analysishospitalizationmortality |
| spellingShingle | Boyang Xiang Zongliang Yu Xiang Zhou Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis Frontiers in Cardiovascular Medicine chronic heart failure medical treatment meta-analysis hospitalization mortality |
| title | Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis |
| title_full | Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis |
| title_fullStr | Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis |
| title_full_unstemmed | Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis |
| title_short | Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis |
| title_sort | comparative efficacy of medical treatments for chronic heart failure a network meta analysis |
| topic | chronic heart failure medical treatment meta-analysis hospitalization mortality |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.787810/full |
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