Recommended HFREF treatments including RAAS inhibitors, beta-blockers, CRT, and ICDs significantly reduced the risk of death by 14-23%, while ICDs increased HF hospitalization risk by 34%.
Meta-Analysis
Do guideline-recommended drugs and devices reduce all-cause mortality and heart failure hospitalization in patients with HFrEF?
This meta-analysis confirms that most guideline-recommended HFrEF treatments offer significant mortality and hospitalization benefits, though caution is needed as many foundational trials are decades old.
The aim of this paper is to evaluate the treatment effects of recommended drugs and devices on key clinical outcomes for patients with heart failure with reduced ejection fraction (HFREF). Randomized controlled trials (RCTs) listed in the 2012 HF guideline from the European Society of Cardiology as well as the 2013 HF guideline from the American College of Cardiology Foundation and American Heart Association were evaluated for use in the meta-analysis. RCTs written in English evaluating recommended drugs and devices for the treatment of patients with HFREF were included. Meta-analyses, based on the outcomes of all-cause mortality and hospitalization because of HF, were performed with relative risk ratio as the effect size. In the identified 47 RCTs, patients were on average 63 years old and 22% were female. Drugs targeting the renin-angiotensin-aldosterone system, beta-blockers, cardiac resynchronization therapy (CRT), and intracardiac defibrillator devices (ICDs) significantly reduced the risk of death with reductions of 14-19, 23, 20, and 20%, respectively. Drugs targeting the renin-angiotensin-aldosterone system, beta-blockers, digoxin, and CRT significantly reduced the risk of HF hospitalization with reductions of 24-37, 22, 60, and 36%, respectively, while ICDs significantly increased the risk with 34%. Ivabradine showed no significant effects on either outcome. As such, the majority of recommended HFREF treatments offered significant treatment benefits. However, many of the included studies were from the 1990s or earlier, and one must therefore be cautious when extrapolating these results to contemporary patients with HF.
Thomsen et al. (Mon,) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFREF). Recommended drugs and devices (RAAS inhibitors, beta-blockers, CRT, ICDs, digoxin, ivabradine) was evaluated on All-cause mortality and hospitalization because of HF. Recommended HFREF treatments including RAAS inhibitors, beta-blockers, CRT, and ICDs significantly reduced the risk of death by 14-23%, while ICDs increased HF hospitalization risk by 34%.
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