(170) Comparative Efficacy of Pharmacological Therapies for Heart Failure with Reduced Ejection Fraction: A Network Meta-Analysis of Randomized Controlled Trials
Graduate assistant University of Florida Gainesville, United States
Background: Evidence for the efficacy of pharmacological therapies for heart failure with reduced ejection fraction (HFrEF) is growing. However, there is no consensus on the most effective treatment for HFrEF.
Objectives: This study aimed to evaluate the comparative efficacy of pharmacological treatments in patients with HFrEF.
Methods: We systematically searched Medline, Embase, and CENTRAL up to Feb 2022, to include randomized controlled trials (RCTs) that evaluated the efficacy of pharmacological treatment among adults (≥18 years) with a diagnosis of HFrEF (defined by a left ventricular ejection fraction ≤ 45%). The outcomes of interest included all-cause mortality, cardiovascular (CV) death, and hospitalization for heart failure (HHF). A random network meta-analysis using a frequentist framework model was employed to calculate the pooled risk ratio (RR) with 95% confidence interval (CI) and rank the treatments using the surface under the cumulative ranking curve score (P-score).
Results: We included 53 RCTs involving 105,498 participants with HFrEF. Sacubitril/valsartan (ARNI) + beta-blocker (BB) was found to be the most effective treatment for decreasing the risk of all-cause mortality (RR, 0.53; 95%CI, 0.37-0.75), followed by angiotensin-converting enzyme inhibitors (ACEi)+BB+renin inhibitor (RI) (0.57 [0.40-0.80]), and ACEI+BB+digoxin (0.58 [0.40-0.85]). Similarly, ARNI+BB had the highest probability to be the effective treatment for reducing the risk of CV death (0.49 [0.35-0.69]), followed by ACEi+BB+RI (0.57 [0.40-0.80]), and ACEI+BB (0.61 [0.47-0.77]). For the risk of HHF, ACEi+BB+digoxin was the most effective treatment (0.38; [0.25-0.57]), followed by ARNI (0.39; [0.25-0.57]), and ARNI+BB (0.41 [0.27-0.62]).
Conclusions: In patients with HFrEF, different medication regimens may have better efficacy than others for reducing all-cause mortality and CV death (e.g., ARNI+BB) and HHF (e.g., ACEI+BB+ digoxin).
