November 6, 2024npj Cardiovascular Health11 citationsOpen Access
Consistency of HFrEF treatment effect in underrepresented groups in randomized clinical trials
Key Result
Guideline-directed medical therapies for HFrEF demonstrate consistent treatment benefits across underrepresented demographic groups, including older adults, females, and racial minorities.
Structured PICO
Does guideline-directed medical therapy have consistent treatment effects in underrepresented demographic groups with HFrEF?
P
Population
Patients with heart failure with reduced ejection fraction (HFrEF), including underrepresented groups (Black, Indigenous, people of color, older adults, females, socioeconomically deprived)
I
Intervention
Guideline-directed medical therapies
O
Outcome
Treatment effect consistency across demographic groups
This review highlights that HFrEF guideline-directed medical therapies have consistent benefits across diverse demographic groups, supporting broad implementation to improve health equity.
Limitations
- Suboptimal reporting of race-related information in RCTs
- Exclusion of women with childbearing potential from pivotal trials
- Lack of information on social and educational levels in RCTs
- Imbalanced subgroups may lack statistical power to detect treatment heterogeneity
Abstract
Despite the established efficacy of heart failure (HF) guideline-directed medical therapies, implementation varies across demographic groups, including Black, Indigenous, and people of color, older adults, females, and those who are socioeconomically deprived. This review synthesizes the representativeness of trial participants and describes subgroup analyses from pivotal trials in HF with reduced ejection fraction (HFrEF). It reviews the largely consistent treatment effect of medical therapies across the demographic groups represented in trials. It makes arguments for broad implementation of therapies based on these data, while calling for more representative trials to improve research and health equity in HF.