Key result
Sildenafil reduced hospital admissions compared with placebo (3.15% vs. 12.20%; RR 0.29; 95% CI 0.11-0.77) in patients with pulmonary hypertension secondary to chronic systolic heart failure.
Why the study?
Does sildenafil reduce hospital admissions and improve hemodynamics in patients with pulmonary hypertension secondary to chronic systolic heart failure?
Meta-Analysis (n=206)
Does sildenafil reduce hospital admissions and improve hemodynamics in patients with pulmonary hypertension secondary to chronic systolic heart failure?
Relative Risk: 0.29 (95% CI 0.11–0.77)
Absolute Event Rate: 3.15% vs 12.2%
In patients with pulmonary hypertension secondary to chronic systolic heart failure, sildenafil significantly reduces hospital admissions and improves hemodynamics, exercise capacity, and quality of life.
Supports sildenafil consideration to reduce admissions in PH from systolic HF; extends RCT evidence on hemodynamics and exercise capacity.
AIMS: Increased indiscriminate use of pulmonary artery hypertension-targeted drugs has been observed in patients with pulmonary hypertension (PH) secondary to heart failure. We performed a meta-analysis to evaluate the chronic effects of using phosphodiesterase 5 (PDE5) inhibitors to treat patients with PH secondary to chronic systolic heart failure. METHODS AND RESULTS: PubMed, EMBASE, and the Cochrane Library were searched up to October 2013 for randomized controlled trials (RCTs) assessing PDE5 inhibitor treatments in PH patients secondary to chronic heart failure. Six RCTs involving 206 chronic systolic heart failure patients with PH complications were included. Sildenafil was used in all trials. Sildenafil treatment resulted in fewer hospital admissions compared with the placebo treatment (3.15% vs. 12.20%; risk ratio 0.29; 95% confidence interval 0.11-0.77). Various haemodynamic parameters were improved with additional sildenafil treatment, including reduced mean pulmonary artery pressure [weighted mean difference (WMD) -5.71 mmHg, P<0.05] and pulmonary vascular resistance (WMD -81.5 dynes/cm(-5), P<0.00001), increased LVEF (WMD 3.95%, P<0.01), and unchanged heart rate and blood pressure. The exercise capacity improved (oxygen consumption at peak exercise, WMD 3.20 mL/min(-1)/kg(-1), P<0.00001; ventilation to CO2 production slope, WMD -5.89, P<0.00001), and the clinical symptoms were relieved based on the breathlessness (WMD 7.72, P<0.00001), fatigue (WMD 2.28, P<0.05), and emotional functioning (WMD 5.92, P<0.00001) scores. CONCLUSIONS: Additional sildenafil treatment is a potential therapeutic method to improve pulmonary exercise capacity and quality of life by ameliorating PH in patients with chronic systolic heart failure.
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Wu et al. (2013) conducted a meta-analysis in Pulmonary hypertension secondary to chronic systolic heart failure (n=206). Sildenafil (Phosphodiesterase 5 inhibitor) vs. Placebo was evaluated on Hospital admissions (RR 0.29, 95% CI 0.11-0.77). Sildenafil reduced hospital admissions compared with placebo (3.15% vs. 12.20%; RR 0.29; 95% CI 0.11-0.77) in patients with pulmonary hypertension secondary to chronic systolic heart failure.
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