Combination Pharmacotherapies for Cardiac Reverse Remodeling in Heart Failure Patients with Reduced Ejection Fraction: A Systematic Review and Network Meta-analysis of Randomized Clinical Trials

Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF.Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes.Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92).Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

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Benefits of Exercise in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2031121 ◽

2021 ◽

pp. 183-198

Author(s):

Reagan F. Cabahug ◽

Gina L. Montalan ◽

Irma P. Yape ◽

Maria Christina M. Laurenciana

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Clinical Trials ◽

Exercise Therapy ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Heart Failure Patients ◽

Therapy Program ◽

All Cause Mortality

Objective: To update Sagar et.al. systematic review and meta-analysis on exercise-based rehabilitation for heart failure. Methods: A systematic review and meta-analysis of randomized clinical trials on exercised-based cardiac rehabilitation. MEDLINE, OVID and cross references were searched for RCTs published between February 2013 up to August 2018. Trials with at least 6 months follow up were included if exercise training program alone or as a component of comprehensive cardiac rehabilitation was compared with groups without exercise prescription. Results: A total of 11,989 patients were included in the 43 randomized clinical trials predominantly with reduced EF and NYHA class ll -lll. Exercise training program prescription in heart failure patients reduced the all-cause mortality (RR=0.76; 95%CI= 0.66, 0.87; P= 0.001), all cause hospitalization after 12 months (RR=0.70; 95% CI= 0.52, 0.96; P= 0.02) rehospitalization due to heart failure (RR= 0.49; 95% CI= 0.44, 0.55; P= <0.0001) and improvement in quality-of-life scores (RR= -0.36; 95% CI= -0.58, -0.14; P= 0.002). Among these health quality related outcomes, the all-cause mortality and the hospitalization admission after 12 months follow up showed a significant association with exercise therapy program, particularly on exercise setting(p=0.026) and exercise dose (p=0.013), respectively, as revealed by the univariate meta-regression results. Conclusion: This study has shown that exercise therapy either in center or home based has benefited heart failure patients in reducing the risk of all-cause mortality up to 12 months, hospital admission up 12 months, and has given a better quality of life. The new studies included have further strengthened the findings of previous studies that an exercise therapy program provides benefit to heart failure patients, either as an “alone” intervention or together with a cardiac rehabilitation program; and that the setting and dose of an exercise therapy program provide significant contribution to a reduced risk in all-cause mortality and hospitalization after 12 months follow up, respectively.

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EFFECTS OF SPIRONOLACTONE ON THE PROGNOSIS OF HEART FAILURE PATIENTS WITH PRESERVED EJECTION FRACTION: A META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34091-3 ◽

2017 ◽

Vol 69 (11) ◽

pp. 702

Author(s):

Yajie Xiang ◽

Wei Huang ◽

Yunjing Yang ◽

Stephen Yishu Wang ◽

Wenhai Shi

Keyword(s):

Heart Failure ◽

Clinical Trials ◽

Ejection Fraction ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Preserved Ejection Fraction ◽

Heart Failure Patients

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Abstract 2391: Impact of Therapies for Anemia on Outcomes in Patients with Heart Failure in Randomized Clinical Trials

Circulation ◽

10.1161/circ.118.suppl_18.s_716-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Howard M Julien ◽

Preetika Muthukrishnan ◽

Eldrin F Lewis

Keyword(s):

Heart Failure ◽

Clinical Trials ◽

Ejection Fraction ◽

Serum Creatinine ◽

Exercise Capacity ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

The Impact

Anemia is common in heart failure (HF) patients and has been well-established as a risk factor for increased risk of HF hospitalization and mortality. Treatment with erythropoietin stimulating agents (ESA) has increased hemoglobin, but outcomes trials are limited and use of ESA has been controversial given disparate results in other populations. This meta-analysis aimed to evaluate the impact of ESA and iron on outcomes in HF patients. A systematic review of four databases was conducted in April 2008 (n = 95 unique trials). Analysis inclusion criteria included randomized controlled trial to ESA/iron with clinically defined HF, yielding 10 eligible trials published between 6/01–3/08. Data was independently extracted and cross-checked for accuracy and reliability (2 investigators). A total of 768 subjects (421 treated and 338 controls) are included (Characteristics in Table 1 ). Randomization to ESA produced a significant improvement in exercise capacity 0.39 standard units [95% CI 0.1– 0.6, p = 0.001], a 5.72% [95% CI 1.2–10.3, p = 0.014] increase in left ventricle ejection fraction and a 0.23 mg/dL [95% CI 0.4 – 0.1 p = 0.001] reduction in serum creatinine. There was no difference in all-cause mortality - RR 0.79 [95% CI 0.49, 1.26, p = 0.320]. Trends were noted in reduced hospitalization rates, decreased brain natriuretic peptide, and improved quality of life. Meta-analysis of randomized studies of treatment of anemia in HF patients suggests significant benefit in exercise capacity, left ventricular ejection fraction, and serum creatinine. There does not appear to be excess mortality with ESA/iron treatment. Despite favorable findings, definitive randomized clinical trials are needed to assess the role of this treatment modality in HF management. Table 1. Baseline Patient and Study Characteristics

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