Blockade of the neurohormonal systems in heart failure with preserved ejection fraction: A contemporary meta-analysis.
Heart failure with preserved ejection fraction
Meta-analysis
Neurohormonal inhibitors
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 10 2020
01 10 2020
Historique:
received:
15
04
2020
revised:
18
05
2020
accepted:
26
05
2020
pubmed:
12
6
2020
medline:
15
5
2021
entrez:
12
6
2020
Statut:
ppublish
Résumé
Although individual studies failed to demonstrate significant benefits with neurohormonal inhibitors in patients affected by heart failure (HF) with preserved ejection fraction (HFpEF), an evident trend towards a reduction in hospitalization and mortality has been previously documented in most cases. We aimed to conduct an updated meta-analysis on the effect of neurohormonal inhibitors [renin-angiotensin-aldosterone system (RAAS) inhibitors and angiotensin receptor neprilysin inhibitors (ARNi)] on the primary composite outcome of mortality and hospitalizations for HF and on the secondary outcomes of mortality and hospitalizations separately analyzed. The extended literature search ended up with the identification of a total of 12 studies cumulatively including 30,882 patients, 16,540 in the treatment and 14,432 in the control groups. Eleven studies explored the outcome of death, 9 studies reported data about HF hospitalizations and 8 studies explored the composite outcome of death and HF hospitalizations. Our meta-analysis showed that treatment with neurohormonal inhibitors was significantly associated with a reduced risk of the primary composite outcome (OR 0.87, 95%CI: 0.82-0.93, p < .001; I Our current work supports a beneficial effect of neurohormonal inhibitors (RAAS blockers and ARNi) on the primary composite outcome of death and HF hospitalizations and on the secondary outcome of HF hospitalizations in HFpEF patients. This finding provides support to the current prevalent clinical approach and to level of evidence reported in the Guidelines.
Sections du résumé
BACKGROUND
Although individual studies failed to demonstrate significant benefits with neurohormonal inhibitors in patients affected by heart failure (HF) with preserved ejection fraction (HFpEF), an evident trend towards a reduction in hospitalization and mortality has been previously documented in most cases. We aimed to conduct an updated meta-analysis on the effect of neurohormonal inhibitors [renin-angiotensin-aldosterone system (RAAS) inhibitors and angiotensin receptor neprilysin inhibitors (ARNi)] on the primary composite outcome of mortality and hospitalizations for HF and on the secondary outcomes of mortality and hospitalizations separately analyzed.
METHODS AND RESULTS
The extended literature search ended up with the identification of a total of 12 studies cumulatively including 30,882 patients, 16,540 in the treatment and 14,432 in the control groups. Eleven studies explored the outcome of death, 9 studies reported data about HF hospitalizations and 8 studies explored the composite outcome of death and HF hospitalizations. Our meta-analysis showed that treatment with neurohormonal inhibitors was significantly associated with a reduced risk of the primary composite outcome (OR 0.87, 95%CI: 0.82-0.93, p < .001; I
CONCLUSION
Our current work supports a beneficial effect of neurohormonal inhibitors (RAAS blockers and ARNi) on the primary composite outcome of death and HF hospitalizations and on the secondary outcome of HF hospitalizations in HFpEF patients. This finding provides support to the current prevalent clinical approach and to level of evidence reported in the Guidelines.
Identifiants
pubmed: 32522678
pii: S0167-5273(20)32057-X
doi: 10.1016/j.ijcard.2020.05.084
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
172-179Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.