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

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

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

Circulation ◽  
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

Effect of ivabradine in heart failure: a meta-analysis of heart failure patients with reduced versus preserved ejection fraction

2021 ◽  
pp. 1-16
Author(s):  
Noémi Tóth ◽  
Alexandra Soós ◽  
Alex Váradi ◽  
Péter Hegyi ◽  
Benedek Tinusz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Clinical Trials ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Preserved Ejection Fraction ◽  
Ventricular Performance

In clinical trials of heart failure reduced ejection fraction (HFrEF), ivabradine seemed to be an effective heart rate lowering agent associated with lower risk of cardiovascular death. In contrast, ivabradine failed to improve cardiovascular outcomes in heart failure preserved ejection fraction (HFpEF) despite the significant effect on heart rate. This meta-analysis is the first to compare the effects of ivabradine on heart rate and mortality parameters in HFpEF versus HFrEF. We screened three databases: PubMed, Embase, and Cochrane Library. The outcomes of these studies were mortality, reduction in heart rate, and left ventricular function improvement. We compared the efficacy of ivabradine treatment in HFpEF versus HFrEF. Heart rate analysis of pooled data showed decrease in both HFrEF (–17.646 beats/min) and HFpEF (–11.434 beats/min), and a tendency to have stronger bradycardic effect in HFrEF (p = 0.094) in randomized clinical trials. Left ventricular ejection fraction analysis revealed significant improvement in HFrEF (5.936, 95% CI: [4.199–7.672], p < 0.001) when compared with placebo (p < 0.001). We found that ivabradine significantly improves left ventricular performance in HFrEF, at the same time it exerts a tendency to have improved bradycardic effect in HFrEF. These disparate effects of ivabradine and the higher prevalence of non-cardiac comorbidities in HFpEF may explain the observed beneficial effects in HFrEF and the unchanged outcomes in HFpEF patients after ivabradine treatment.

scholarly journals Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis

2016 ◽  
Vol 86 (1-2) ◽  
Author(s):  
Erick Chan ◽  
Francesco Giallauria ◽  
Carlo Vigorito ◽  
Neil A. Smart
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Short Form ◽  
Meta Analysis ◽  
Systolic Dysfunction ◽  
Preserved Ejection Fraction ◽  
Medline Search ◽  
Heart Failure Patients

<p>Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection fraction. This study's aims were to establish if exercise training produces changes in peak VO<sub>2</sub> and related measures, quality of life, general health and diastolic function in heart failure patients with preserved ejection fraction (HFpEF). We conducted a MEDLINE search (1985 to September 1, 2015), for exercise based rehabilitation trials in heart failure, using search terms ‘exercise training, heart failure with preserved ejection fraction, heart failure with  normal ejection fraction, peak VO<sub>2</sub> and diastolic heart dysfunction’. Eight intervention studies were included providing a total of 174 exercising subjects and 143 control subjects, a total of 317 participants. Peak VO<sub>2</sub> increased by a mean difference (MD) 2.08 mL kg<sup>-1 </sup>min<sup>-1</sup> (95% C.I. 1.51 to 2.65, p&lt;0.00001) in exercise training versus sedentary control, equating to a 17% improvement from baseline. V<sub>E</sub>/VCO<sub>2</sub> slope was not different between groups, MD -3.10 mL kg<sup>-1 </sup>min<sup>-1</sup> (95% C.I. -7.47 to 1.27, p=0.16); maximum heart rate was significantly increased in exercise groups, MD 3.46 bpm (95% C.I. 2.41 to 4.51, p&lt;0.00001); 6 Minute Walk Distance (6MWT) MD 32.1m (95% C.I. 17.2 to 47.1, p&lt;0.0001); diastolic  function; the ratio of early to late filling (E/A ratio) was improved after exercise training MD 0.07 (95% C.I. 0.02 to 0.12, p=0.006); as was filling pressure E/E’ ratio MD -2.38 (95% C.I. -3.47 to -1.28, p&lt;0.0001); Deceleration time (D<sub>T</sub>) MD -13.2 msec (95% C.I. -19.8 to -6.5, p=0.0001); Minnesota Living with Heart Failure Questionnaire (MLHFQ) MD -6.77 (95% C.I. -9.70 to -3.84, p&lt;0.00001); Short Form (36) Health Survey MD 11.38 (95% C.I. 5.28 to 17.48, p=0.0003).  In 3222 patient-hours of training, not a single death was directly attributable to exercise. Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction.</p>

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

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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