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Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis

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Drug treatment effects on outcomes in heart failure with preserved ejection fraction : a systematic review and meta-analysis. / Zheng, Sean Lee ; Chan, Fiona T; Nabeebaccus, Adam A; Shah, Ajay M; McDonagh, Theresa; Okonko, Darlington O; Ayis, Salma.

In: Heart, Vol. 104, No. 5, 12.02.2018, p. 407-415.

Research output: Contribution to journalArticle

Harvard

Zheng, SL, Chan, FT, Nabeebaccus, AA, Shah, AM, McDonagh, T, Okonko, DO & Ayis, S 2018, 'Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis', Heart, vol. 104, no. 5, pp. 407-415. https://doi.org/10.1136/heartjnl-2017-311652

APA

Zheng, S. L., Chan, F. T., Nabeebaccus, A. A., Shah, A. M., McDonagh, T., Okonko, D. O., & Ayis, S. (2018). Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Heart, 104(5), 407-415. https://doi.org/10.1136/heartjnl-2017-311652

Vancouver

Zheng SL, Chan FT, Nabeebaccus AA, Shah AM, McDonagh T, Okonko DO et al. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Heart. 2018 Feb 12;104(5):407-415. https://doi.org/10.1136/heartjnl-2017-311652

Author

Zheng, Sean Lee ; Chan, Fiona T ; Nabeebaccus, Adam A ; Shah, Ajay M ; McDonagh, Theresa ; Okonko, Darlington O ; Ayis, Salma. / Drug treatment effects on outcomes in heart failure with preserved ejection fraction : a systematic review and meta-analysis. In: Heart. 2018 ; Vol. 104, No. 5. pp. 407-415.

Bibtex Download

@article{cb95740aee1448bdb678b9d5f3c8863a,
title = "Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis",
abstract = "Background Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality.Methods We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40{\%} from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95{\%} CI.Results We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95{\%}CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo.Conclusion The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40{\%} differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group.",
author = "Zheng, {Sean Lee} and Chan, {Fiona T} and Nabeebaccus, {Adam A} and Shah, {Ajay M} and Theresa McDonagh and Okonko, {Darlington O} and Salma Ayis",
year = "2018",
month = "2",
day = "12",
doi = "10.1136/heartjnl-2017-311652",
language = "English",
volume = "104",
pages = "407--415",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group Ltd",
number = "5",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Drug treatment effects on outcomes in heart failure with preserved ejection fraction

T2 - a systematic review and meta-analysis

AU - Zheng, Sean Lee

AU - Chan, Fiona T

AU - Nabeebaccus, Adam A

AU - Shah, Ajay M

AU - McDonagh, Theresa

AU - Okonko, Darlington O

AU - Ayis, Salma

PY - 2018/2/12

Y1 - 2018/2/12

N2 - Background Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality.Methods We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI.Results We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo.Conclusion The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group.

AB - Background Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality.Methods We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI.Results We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo.Conclusion The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group.

UR - http://www.scopus.com/inward/record.url?scp=85042000773&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2017-311652

DO - 10.1136/heartjnl-2017-311652

M3 - Article

VL - 104

SP - 407

EP - 415

JO - Heart

JF - Heart

SN - 1355-6037

IS - 5

ER -

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