NYMC Faculty Publications

Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Network Meta-Analysis

Authors

Jayakumar Sreenivasan, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.
Aaqib Malik, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.Follow
Muhammad Shahzeb Khan, Duke Clinical Research Institute, Durham, NC.
Amanda Lloji, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.
Urvashi Hooda, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.
Wilbert S. Aronow, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.Follow
Gregg M. Lanier, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.Follow
Stephen Pan, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.Follow
Stephen J. Greene, Duke Clinical Research Institute, Durham, NC.
M Hassan Murad, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN.
Erin D. Michos, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Howard A. Cooper, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.Follow
Alan Gass, New York Medical CollegeFollow
Rahul Gupta, Division of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.Follow
Nihar R. Desai, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
Robert J. Mentz, Duke Clinical Research Institute, Durham, NC.
William H. Frishman, Department of Medicine, New York Medical College, Valhalla, NY.
Julio A. Panza, From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY.Follow

Author Type(s)

Faculty

DOI

10.1097/CRD.0000000000000484

Journal Title

Cardiology in Review

First Page

114

Last Page

123

Document Type

Article

Publication Date

3-1-2024

Department

Medicine

Abstract

Various pharmacotherapies exist for heart failure with preserved ejection fraction (HFpEF), but with unclear comparative efficacy. We searched EMBASE, Medline, and Cochrane Library from inception through August 2021 for all randomized clinical trials in HFpEF (EF >40%) that evaluated beta-blockers, mineralocorticoid receptor antagonist (MRA), angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitor (ARNI), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Outcomes assessed were cardiovascular mortality, all-cause mortality, and HF hospitalization. A frequentist network meta-analysis was performed with a random-effects model. We included 22 randomized clinical trials (30,673 participants; mean age = 71.7 ± 4.2 years; females = 49.3 ± 7.7%; median follow-up = 24.4 ± 11.1 months). Compared with placebo, there was no statistically significant difference in cardiovascular mortality [beta-blockers; odds ratio (OR) 0.79 (0.46-1.34), MRA; OR 0.90 (0.70-1.14), ACE OR 0.95 (0.59-1.53), ARB; OR 1.02 (0.87-1.19), ARNI; OR 0.97 (0.74-1.26) and SGLT2i; OR 1.00 (0.84-1.18)] or all-cause mortality [beta blockers; OR 0.75 (0.54-1.04), MRA; OR 0.90 (0.75-1.08) ACE; OR 1.05 (0.71-1.54), ARB; OR 1.03 (0.91-1.15), ARNI; OR 0.99 (0.82-1.20) and SGLT2i; OR 1.00 (0.89-1.13)]. The certainty in these estimates was low or very low. There was a significantly reduction in HF hospitalization with the use of SGLT2i [OR 0.71 (0.62-0.82), moderate certainty], ARNI [OR 0.77 (0.63-0.94), low certainty], and MRA [OR 0.81 (0.66-0.98), moderate certainty]; with corresponding P scores of 0.84, 0.68, and 0.58, respectively. In HFpEF, the use of beta-blockers, MRA, ACE/ARB/ARNI, or SGLT2i was not associated with improved cardiovascular or all-cause mortality. SGLT2i, ARNI, and MRA reduced the risk of HF hospitalizations.

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