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September 2, 2023Current Heart Failure ReportsOpen Access

ACE inhibitors and beta-blockers benefit HFrEF while MRAs favor young obese males and metabolic HFpEF.

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Why the study?

This review was conducted to summarise key findings on treatment effects within phenotypical clusters of patients with heart failure, distinguishing between patients with HFpEF and HFrEF.

Does treatment response to guideline-directed medical therapies differ across phenotypical clusters in patients with heart failure?

Design

Review

Key result

Treatment response differs among heart failure clusters, with ACE inhibitors and beta-blockers beneficial in HFrEF but not HFpEF, while MRAs benefit young, obese males and metabolic HFpEF patients.

Authors

MVMariëlle C. van de VeerdonkGSGianluigi SavareseMHM. Louis Handoko

Discussion

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Overview

Cluster differences in GDMT response remain hypothesis-generating; leaves open validation before phenotype-guided use.

Key Points

  • To summarize therapeutic responses across distinct phenotypical clusters in patients with heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF).
  • Reviewed clinical trial and observational literature examining cluster analysis-derived phenotypes and medical therapy efficacy in HFpEF and HFrEF populations.
  • ACE inhibitors and beta-blockers consistently improve outcomes in all HFrEF phenotypes, but beta-blockers show no benefit in HFpEF and worsen prognosis in older patients with cardiorenal disease.
  • Mineralocorticoid receptor antagonists show greater prognostic benefit in young, obese male and metabolic HFpEF clusters.
  • Phenotype-guided treatment strategies require further clinical trial and real-world validation prior to routine clinical integration.

Structured PICO

Does treatment response to guideline-directed medical therapies differ across phenotypical clusters in patients with heart failure?

P
Population
Patients with heart failure (HFrEF and HFpEF) categorized into phenotypical clusters (e.g., young-low comorbidity, metabolic, cardiorenal, atrial fibrillation, ischaemic).
I
Intervention
Heart failure medical therapies (ACE inhibitors, ARBs, beta-blockers, MRAs, SGLT2 inhibitors, ARNI) evaluated within specific phenotypical clusters.

Heart failure treatment responses vary significantly across phenotypical clusters, suggesting that a tailored, phenotype-guided approach could optimize therapy, though stronger evidence is needed before clinical implementation.

Limitations

  • Several studies were observational and prone to confounding by indication and selection bias.
  • Clinical trials are often underpowered to detect differences in treatment effects across clusters.
  • Only a handful of studies assessed statistical interaction between treatment and clusters.
  • Phenotypes are generally not mutually exclusive, hampering the consolidation of available evidence.
  • Observational nature of some included studies prone to confounding by indication and selection bias
  • Clinical trials are often underpowered to detect differences in treatment effects across clusters
  • Few studies assessed statistical interaction between treatment and clusters
  • Phenotypes are generally not mutually exclusive

Cite This Study

Veerdonk et al. (2023) conducted a review in Heart Failure. Heart failure medications was evaluated. Treatment response differs among heart failure clusters, with ACE inhibitors and beta-blockers beneficial in HFrEF but not HFpEF, while MRAs benefit young, obese males and metabolic HFpEF patients.

synapsesocial.com/papers/6a15826037103a43379fd6fahttps://doi.org/10.1007/s11897-023-00626-w
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