Key result
No pharmacological therapies significantly reduced all-cause mortality compared to placebo, though ARNI and ACEI significantly reduced the risk of heart failure hospitalizations.
Why the study?
Beneficial effects of therapeutic drugs in heart failure with preserved ejection fraction remain controversial.
Do pharmacological treatments reduce mortality and heart failure events in patients with HFpEF?
Meta-Analysis (n=19,573)
Do pharmacological treatments reduce mortality and heart failure events in patients with HFpEF?
ARNI and ACEI are associated with a lower risk of heart failure hospitalizations in patients with HFpEF, although no pharmacological therapy significantly reduces mortality.
ARNI and ACEI remain appropriate for lowering HF hospitalizations; reinforces that mortality reduction stays elusive across current HF pharmacotherapies.
Beneficial effects of therapeutic drugs are controversial for heart failure with preserved ejection fraction (HFpEF). This meta-analysis aimed to evaluate and compare the interactive effects of different therapeutic drugs and placebo in patients with HFpEF. A comprehensive search was conducted using PubMed, Google Scholar, and Cochrane Central Register to identify related articles published before March 2021. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure (HF) hospitalization, and worsening HF events. A total of 14 randomized controlled trials, comprising 19,573 patients (intervention group, n = 9,954; control group, n = 9,619) were included in this network meta-analysis. All-cause mortality, cardiovascular mortality, and worsening HF events among therapeutic drugs and placebo with follow-up of 0.5–4 years were not found to be significantly correlated. The angiotensin receptor neprilysin inhibitor (ARNI) and angiotensin-converting enzyme inhibitor (ACEI) significantly reduced the HF hospitalizations compared with placebo (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.60–0.87 and HR 0.64, 95% CI 0.43–0.96, respectively), without heterogeneity among studies. The ARNI was superior to angiotensin receptor blocker (ARB) in reducing HF hospitalizations (HR 0.80, 95% CI 0.71–0.91), and vericiguat 10 mg ranked worse than beta-blockers for reducing all-cause mortality in patients with HFpEF (HR 3.76, 95% CI 1.06–13.32). No therapeutic drugs can significantly reduce mortality, but the ARNI or ACEI is associated with the low risk of HF hospitalizations for patients with HFpEF. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021247034
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Lin et al. (2021) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=19,573). Pharmacological therapies (ARNI, ACEI, ARB, beta-blockers, MRAs, digoxin, sildenafil, vericiguat) vs. Placebo was evaluated on All-cause mortality. No pharmacological therapies significantly reduced all-cause mortality compared to placebo, though ARNI and ACEI significantly reduced the risk of heart failure hospitalizations.
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