Key result
Target RASI doses cut all-cause mortality ~8% vs sub-target doses in elderly HFrEF patients.
Why the study?
The efficiency of target versus sub-target doses of renin-angiotensin system inhibitors in elderly patients with heart failure with reduced ejection fraction remains unclear.
Does the target dose of renin-angiotensin system inhibitors reduce all-cause mortality in elderly patients (≥ 60 years) with HFrEF compared to sub-target doses?
Meta-Analysis (n=16,634)
Does the target dose of renin-angiotensin system inhibitors reduce all-cause mortality in elderly patients (≥ 60 years) with HFrEF compared to sub-target doses?
Target doses of RASIs provide a survival benefit over sub-target doses in elderly patients with HFrEF, though this benefit may be attenuated in very elderly patients (> 75 years).
Supports target RASI dosing in elderly HFrEF; extends meta-analytic evidence while leaving benefit uncertain in those >75 years.
BACKGROUND The efficiency of the target versus sub-target dose of renin–angiotensin system inhibitors (RASIs) in elderly patients with heart failure (HF) with reduced ejection fraction (HErEF) remains unclear. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from database inception through March 2022 for randomized controlled trials (RCTs) and observational studies considering the effect of the target versus sub-target dose of RASIs on survival in elderly patients (≥ 60 years) with HErEF. The primary outcome was all-cause mortality. The secondary outcomes were cardiac mortality, HF hospitalization, and the composite endpoint of mortality or HF hospitalization. A meta-analysis was conducted to generate combined hazard ratio (HR) and 95% CI. RESULTS Seven studies (two RCTs and five observational studies) enrolling 16,634 patients were included. A pooled analysis suggested that the target versus sub-target dose of RASIs led to lower rates of all-cause mortality (HR = 0.92, 95% CI: 0.87–0.98, I² = 21%) and cardiac mortality (HR = 0.93, 95% CI: 0.85–1.00, I² = 15%) but not reduced rates of HF hospitalization (HR = 0.94, 95% CI: 0.88–1.01, I² = 0) and the composite endpoint (HR = 1.03, 95% CI: 0.91–1.15, I² = 51%). However, the target dose of RASIs was associated with a similar primary outcome (HR = 0.85, 95% CI: 0.64–1.14, I² = 0) in a subgroup of very elderly patients > 75 years of age. CONCLUSIONS Our analysis suggests that the target dose of RASIs has a better survival benefit in elderly patients with HFrEF compared to the sub-target dose of RASIs. However, the sub-target dose of RASIs is associated with a similar mortality rate in very elderly patients > 75 years of age. Future high-quality and adequately powered RCTs are warranted.
No takes yet. Share an insight, caveat, or question.
SUN et al. (2023) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) (n=16,634). Renin-angiotensin system inhibitors (RASIs) vs. Sub-target dose was evaluated on All-cause mortality (HR 0.92, 95% CI 0.87-0.98). Target doses of renin-angiotensin system inhibitors led to lower all-cause mortality compared to sub-target doses in elderly patients with HFrEF (HR 0.92; 95% CI 0.87-0.98).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: