scholarly journals The Role of SGLT2 Inhibitors in Heart Failure: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Vasiliki Tsampasian ◽  
Ranu Baral ◽  
Rahul Chattopadhyay ◽  
Maciej Debski ◽  
Shruti S Joshi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Total Population ◽  
Meta Analysis ◽  
Sglt2 Inhibitors ◽  
Cochrane Library ◽  
Diabetes Status ◽  
Patients With Heart Failure ◽  
Patients With Diabetes ◽  
Randomised Controlled

Aims. Recent randomised controlled trials (RCTs) have shown a significant prognostic benefit of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the cardiovascular (CV) profile of patients with diabetes. This systematic review and meta-analysis aim to provide a concise evaluation of all the available evidence for the use of these agents in patients with heart failure (HF) regardless of their baseline diabetes status. Methods and Results. PubMed, Web of Science, and Cochrane library databases were systematically searched from inception until November 20th 2020. Eight studies consisting of 13,275 patients were included in the meta-analysis. For the total population, SGLT2 inhibitors reduced the risk of all-cause mortality (HR: 0.83; 95% CI: 0.75–0.91; I2 0%), hospitalisation for HF (HR: 0.68; 95% CI: 0.61–0.75; I2: 0%), CV death (HR: 0.82; 95% CI: 0.74–0.92; I2: 0%), and hospitalisation for HF or CV death (HR: 0.72; 95% CI: 0.66–0.78; I2: 0%). Subgroup analyses of the total population according to the diabetes status showed that SGLT2 inhibitors significantly reduced the risk of hospitalisation for HF (HR: 0.68; 95% CI: 0.61, 0.75; I2: 0%), as well as the risk of hospitalisation for HF or CV death (HR: 0.72; 95% CI: 0.66, 078; I2: 0%) and CV death (HR: 0.82; 95% CI: 0.74, 0.91; I2: 0%). Conclusions. The results of this meta-analysis confirm the growing evidence in the literature of the favourable profile of SGLT2 inhibitors in cardiovascular outcomes and mortality in patients with heart failure regardless of the baseline diabetes status. This systematic review has been registered with PROSPERO (CRD42021224777).

scholarly journals How Does HbA1c Predict Mortality and Readmission in Patients with Heart Failure? A Protocol for Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Junpeng Xu ◽  
Ruixiang Zeng ◽  
Xiaoyi Mai ◽  
Wenjun Pan ◽  
Yuzhuo Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Predictive Value ◽  
Meta Analysis ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Hba1c Levels

Abstract BackgroundAccumulating evidence suggests that HbA1c levels, a common clinical indicator of chronic glucose metabolism over the preceding 2-3 months, are independent risk factor for cardiovascular disease, including heart failure. The aim of this protocol is to conduct a systematic review and meta-analysis to assess the possible predictive value of HbA1c on mortality and readmission in patients with heart failure.MethodsA systematic and comprehensive search will be performed using PubMed, Embase, Central and other databases before August 2021 to identify relevant trials. All-cause mortality is the pre-specified primary endpoint. Cardiovascular death and heart failure readmission are secondary interested endpoints. We will only include prospective and retrospective cohort trials and place no restrictions on the language, race, region and publication period. The Newcastle-Ottawa Scale will be used to assess the quality of each trial included. If there are sufficient trials, we will conduct meta-analysis with pooled relative risks and corresponding 95% confidence interval to evaluate the possible predictive value of HbA1c on mortality and readmission. Otherwise, we will undertake a narrative synthesis. Heterogeneity and publication bias will be assessed. If heterogeneity is significant among included trails, a sensitivity analysis or subgroup analysis will be used to explore the source of heterogeneity, such as diverse types of heart failure or patients with diabetes and non-diabetes. Also, we will conduct meta-regression to examine the time-effect and treatment-effect modifiers on all-cause mortality compared between different quantile of HbA1c levels. Finally, a restricted cubic spline model may be used to explore the dose-response relationship between HbA1c and adverse outcomes.DiscussionThis planned analysis is anticipated to identify the predictive value of HbA1c on mortality and readmission in patients with heart failure. Improved understanding of different HbA1c levels and their specific effect on diverse types of heart failure or patients with diabetes and non-diabetes is expected to be figured out. Also, a dose-response relationship or optimal range of HbA1c will be determined to instruct clinicians and patients.PROSPERO registration detailsCRD42021276067

scholarly journals SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: A systematic review and meta-analysis

2021 ◽  
pp. 100933
Author(s):  
Rhanderson Cardoso ◽  
Fabrissio P. Graffunder ◽  
Caique M.P. Ternes ◽  
Amanda Fernandes ◽  
Ana V. Rocha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Sglt2 Inhibitors ◽  
Patients With Heart Failure

P5732Effects of blood pressure lowering drugs in heart failure: a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A C Pinho-Gomes ◽  
L Azevedo ◽  
Z Bidel ◽  
M Nazarzadeh ◽  
E Copland ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Blood Pressure ◽  
Clinical Outcomes ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Patients With Heart Failure ◽  
Pressure Lowering ◽  
Randomised Controlled

Abstract Background Observational studies have reported a J-shaped relationship between blood pressure (BP) and all-cause and cardiovascular mortality in patients with heart failure (HF). Although decreasing BP significantly reduces the risk of fatal and non-fatal cardiovascular outcomes in the general population across a range of baseline BP categories, the extent to which those findings are applicable to HF patients and whether the relationship holds true when baseline BP is very low remain unclear. Therefore, it is yet to be established whether the observed J-shaped relationship between BP and clinical outcomes in patients with HF is causal and/or modified by antihypertensive treatment. Purpose We aimed to combine evidence from all HF trials that have investigated the effects of drugs with BP-lowering properties to assess (1) the extent to which such drugs reduce BP in HF, (2) the association between the net change in BP between treatment arms and cause-specific outcomes, and (3) whether treatment effects (including benefits and potential harms) vary according to baseline BP. Methods We conducted a systematic review and meta-analysis including randomised clinical trials of drugs with BP-lowering properties conducted in patients with chronic HF with at least 300 patient-years follow-up. Results We included a total of 37 trials (91,950 patients) and showed that treatment with drugs with BP-lowering properties significantly reduced SBP by 2.0 mmHg in all trials and by 2.4 mmHg in placebo-controlled trials (Figure 1). There was no evidence that BP reduction in placebo-controlled trials varied across strata of baseline BP, but there was suggestive evidence for differential effects by drug class, with renin-angiotensin-aldosterone system inhibitors reducing SBP by 3.2 mmHg (95% CI [−4.0, −2.4]), whilst BB appeared to have a neutral effect on BP. There was no evidence that the relative risk reduction afforded by treatment with BP-lowering drugs on all-cause mortality, cardiovascular mortality and HF hospitalisation was significantly different across categories of baseline BP. There was also no strong evidence for heterogeneity of treatment effect on adverse events leading to treatment discontinuation by baseline BP. Meta-regression did not show significant associations between the magnitude of BP reduction achieved in each trial and risk of those clinical outcomes. Figure 1 Conclusions Treatment with drugs with BP-lowering properties resulted in a small but significant decrease in SBP in patients with HF irrespective of baseline BP. There was no evidence that the effects of those drugs differed across the range of baseline SBP, thus supporting the efficacy and safety of those drugs in patients with low baseline BP. Data from published reports was insufficient to adequately investigate whether BP-dependent mechanisms contribute to the effect of BP-lowering drugs on clinical outcomes in patients with HF. Acknowledgement/Funding None

scholarly journals Effect of Baduanjin exercise on patients with chronic heart failure: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028771 ◽  
Author(s):  
Jieying Li ◽  
Feng Yu ◽  
Na Huang ◽  
Jianhui Lu ◽  
Weixian Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Evaluation System ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Funnel Plot ◽  
Meta Regression Analysis ◽  
Randomised Controlled

IntroductionChronic heart failure (CHF) is defined when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs, and it is caused by various cardiopulmonary diseases. CHF is a common, lifelong and costly condition. Baduanjin exercise (BDJE), a form of traditional Chinese regimen, has been integrated into China’s clinical practice in recent years and has shown promise in cardiac rehabilitation of CHF patients. However, the efficacy of BDJE on CHF patients has not been fully statistically evaluated. In this study, we aim to systematically examine the efficacy and safety of BDJE for CHF patients.Methods and analysisA systematic literature search for articles up to October 2018 will be conducted in the following databases: Web of Science, Pubmed, Embase, Cochrane Library, Chinese Science and Technology Periodicals Database, Chinese National Knowledge Infrastructure and Wanfang Database. We will also search other resources. Randomised controlled trials that examined treatment of CHF patients with BDJE will be selected. Results will be analysed by assessing the quality of life of patients using the Minnesota living with heart failure questionnaire, and measurement of distance walked over a span of 6 min in the 6 min walk test. RevMan 5.3 will be used for data synthesis, sensitivity analysis, meta-regression analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias, and Begg and Egger tests will be used to assess funnel plot symmetries. Grading of recommendations assessment, development and evaluation system will be utilised to assess the quality of evidence.Ethics and disseminationThis systematic review will be submitted to a peer-reviewed journal.PROSPEROregistration numberCRD42018114672.

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