Abstract 3215: Effects of Selective and Non-Selective Beta-Blockers on Cardiovascular Risk in Patients with Heart Failure or Acute Coronary Syndrome: a Meta-Analysis.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Olav R de Peuter ◽  
Federico Lussana ◽  
Pieter W Kamphuisen
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Mortality ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Total Mortality ◽  
Cochrane Library ◽  
Mortality And Morbidity ◽  
Coronary Syndrome ◽  
Patients With Heart Failure

Background: Guidelines generally recommend the use of beta-blockers in patients with heart failure (HF) and acute coronary syndrome (ACS). It has recently been suggested that non-selective beta-blockers were more effective than selective beta-blockers in HF. However, a better efficacy of different beta-blockers, specifically analyzing total and cardiovascular (CV) mortality and morbidity, in patients with HF or ACS is unclear. Methods: We performed a meta-analysis of randomized controlled trials (RCTs) through Medline, EMBASE, and Cochrane Library databases to identify RCTs comparing selective or non-selective beta-blockers with placebo (29 studies, 31,856 patients), or directly comparing the two different beta-blockers (5 studies, 3,733 patients). Studies were selected using a priori defined criteria and data on study characteristics, study quality and outcomes were abstracted. All included studies had (cardiovascular) mortality as primary or secondary endpoint. Results: In patients with HF non-selective beta-blockers were associated with a reduction in total mortality (RR 0.75, 95%CI 0.61–0.92), and with a non significant decrease in CV mortality. Selective beta-blockers decreased total and CV mortality (RR 0.76, 0.68–0.84 and RR 0.78, 0.66–0.92, respectively). In patients with ACS non-selective beta-blockers were associated with a significant decrease in total mortality (RR 0.73, 0.64–0.82), CV mortality (RR 0.69, 0.60–0.80) and CV morbidity. Selective beta-blockers however had no effect on total mortality (RR 0.88, 0.68–1.15) or CV mortality (RR 0.89, 0.69–1.15). In HF, direct comparison showed a significantly decreased mortality (RR 0.86, 0.78–0.94) for non-selective beta-blockers compared to selective beta-blockers. For ACS, only one study directly compared different beta-blockers. Conclusions: In patients with HF, selective and non-selective beta-blockers seem equally effective in reducing mortality. In patients with ACS, selective beta-blockers had no influence on total and cardiovascular mortality, in contrast to non-selective beta-blockers. This meta-analysis suggests that patients with ACS should specifically be treated with non-selective beta-blockers to reduce total and cardiovascular mortality.

MO723EFFICACY AND SAFTY OF DAPAGLIFLOZIN FOR HEART FAILURE: A SYSTEMIC REVIEW

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Zhe Wang
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Kansas City ◽  
Meta Analysis ◽  
Research Quality ◽  
Systemic Review ◽  
Cochrane Library ◽  
Control Group ◽  
Volume Depletion ◽  
Patients With Heart Failure

Abstract Background and Aims Dapagliflozin is an inhibitor of sodium-dependent glucose transporters 2, which is a new drug for diabetes mellitus. Recent researches indicated that among patients with heart failure, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than those who received placebo, regardless of the presence or absence of diabetes. This systematic review aimed to evaluate efficacy and safety of dapagliflozin for heart failure. Method According to the collaborative search strategy, MEDLINE(1966-2020.9), Embase(1974-2020.9), Chinese Wanfang database(1996-2020.9),CNKI(1979-2020.9), the clinical control test database of Cochrane Library and were searched. Only randomized controlled trials (RCT) were included in this research. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was conducted by Stata 11.0. Results A total of 5 RCTs were identified which met the inclusion criteria, including 5998 patients. Compared with control group, dapagliflozin was associated with a lower risk of cardiovascular mortality/hospitalization for heart failure composite events (HR=0.73, 95%CI 0.64∼0.83, P<0.001), cardiovascular mortality (RR=0.80, 95%CI 0.68∼0.93, P=0.005), hospitalization for heart failure (HR=0.68, 95%CI 0.58∼0.80, P<0.001), and all-cause mortality (RR=0.80, 95%CI 0.70∼0.92, P=0.002). Dapagliflozin also increased the Kansas city cardiomyopathy questionnaire (KCCQ), without increasing the risk of major hypoglycemia, volume depletion, renal adverse event and amputation. Conclusion Dapagliflozin could effectively lower the risk of mortality and hospitalization for heart failure, as well as improve the quality of life among patients with heart failure.

scholarly journals The safety and efficacy of SDLT-2 (Sodium-glucose co-transporter 2) inhibitor versus placebo in the treatment of heart failure in patients with or without T2DM (Type 2 diabetes mellitus): A Systemic Review and Meta-analysis.

2020 ◽  
Author(s):  
Qian Zhang ◽  
Xiaofei Wang ◽  
Peipei Ge ◽  
Aizhen Hu ◽  
Xuexun Li
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Sglt2 Inhibitor ◽  
Systemic Review ◽  
Cochrane Library ◽  
Volume Depletion ◽  
Patients With Heart Failure ◽  
Safety Outcomes

Abstract Background Sodium-glucose co-transporter 2 (SGLT2) inhibitor which is a type of drug used for the treatment of diabetes mellitus, has been reported by many trials that it could be beneficial for patients with established heart failure. A meta-analysis on this subject could obtain more reliable estimates of the efficacy and safety outcomes. Methods A systematic review and meta-analysis of randomized, placebo-controlled trials of SGLT2 inhibitor in patients with heart failure was conducted. We searched PubMed, Cochrane Library, and Web of Science for trials published from inception to March, 2018. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to conduct the review. For quality assessment of included studies. The methodological quality of the included trials was assessed using the Cochrane tool for assessing randomized clinical trials (RCT). Efficacy outcomes included hospitalization for heart failure and all-cause death. Safety outcomes consisted of serious adverse event (SAE) and volume depletion. Results We included data from 5 identified studies and 8775 patients (aged 64.9, female 29.8%). A total of 3930 (44.8%) patients were known to have diabetes mellitus. Compared with placebo, SGLT2 inhibitor decrease the incidence of hospitalization for heart failure (RR 0.692; 95%CI, 0.611-0.784 P<0.001), and all-cause death (RR 0.824; 95%CI, 0.736-0.922 P=0.001). The incidence of SAE in patients with a treatment of SGLT2 inhibitor was low (RR 0.869; 95%CI, 0.779-0.970 P=0.012). SGLT2 inhibitor didn’t increase the incidence of volume depletion (RR1.165, 95%CI, 0.977-1.390 P=0.089). Conclusion Our results confirm that SGLT2 inhibitor is effective and safe for patients with heart failure regardless of presence of diabetes mellitus.

PERSONIFIED MONITORING OF ACUTE CORONARY SYNDROME AND ITS OUTCOMES IN ELDERLY PATIENTS. ANGINA. HEART FAILURE (OVERVIEW)

2020 ◽  
pp. 92-98
Author(s):  
А. С. Пушкин
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Diagnostic Tests ◽  
Diagnostic Process ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Patients With Heart Failure

В обзорной статье собраны современные представления об особенностях диагностики и мониторинга пациентов пожилого и старческого возраста с сердечной недостаточностью и стенокардией. Особое внимание уделено проблеме коморбидности пациентов старше 65 лет, что требует корректирующих действий при стратификации риска и прогнозировании клинических исходов. Отмечена приоритетность неинвазивных диагностических тестов. Рекомендована оценка хрупкости как неотъемлемой части диагностического процесса пациентов с сердечной недостаточностью и стенокардией ввиду чёткой связи с худшим прогнозом с точки зрения качества жизни, госпитализации и смертности. Review is about current information on the features of heart failure and angina diagnosis and monitoring in elderly and senile patients. One of the main problem in patients over 65 years is comorbidity, which requires corrective action in the risk stratification and prediction of clinical outcomes. The priority of non-invasive diagnostic tests is noted. Authors of the article recommend frailty as an obligatory part of diagnostic process in patients with heart failure and angina due to a clear connection with the worst prognosis in terms of quality of life, hospitalization and mortality.

Abstract 901: Effects of Bucindolol on Cardiovascular Mortality and Morbidity are Determined by the Beta-1 389 Arg/Gly Receptor Polymorphism

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michel White ◽  
Peter Carson ◽  
Inder S Anand ◽  
Stephen S Gottlieb ◽  
JoAnn Lindenfeld ◽  
...  
Keyword(s):  
Heart Failure ◽  
Amino Acid ◽  
Cardiovascular Mortality ◽  
Nyha Class ◽  
Total Mortality ◽  
Chronic Administration ◽  
Amino Acid Position ◽  
Class Iii ◽  
Mortality And Morbidity ◽  
The Impact

Introduction: Bucindolol is a nonselective beta-adrenergic blocker with potent sympatholytic properties. The Beta-blocker Evaluation of Survival Trial (BEST) reported that the administration of bucindolol resulted in a nonsignificant decrease in total mortality (HR = 0.89 (0.78, 1.02), unadjusted p=0.10) in patients with advanced, NYHA Class III-IV heart failure (HF). Recent observations from that trial also reported that the amino acid arginine (Arg/Arg) or glycine (any Gly) in position 389 of the beta-1 receptor plays a significant role on the clinical response to bucindolol. The impact of bucindolol on cardiovascular mortality and morbidity (cardiovascular hospitalizations) has been incompletely investigated, because hospitalizations had been evaluated from case report forms (CRFs) only, and never adjudicated by the endpoints committee (EPC). Methods: The BEST data base consists of 2708 patients with a mean follow-up of 2.0 years. Cardiovascular (CV) mortality and hospitalizations have now been evaluated by EPC, which further subclassified total hospitalizations into cardiovascular (CV) and those due to worsening heart failure (HF). The impacts of Arg or Gly encoded at amino acid position 389 on endpoints were further investigated in the 1040 patient substudy. Results: Time to event results for adjudicated CV endpoints are presented below. Conclusions: Chronic administration of bucindolol results in a significant reduction in cardiovascular hospitalizations and mortality. Effects on either are strikingly beta-1 389 Arg/Gly specific, with the higher functioning, Arg/Arg version of the receptor associated with large treatment effects and Gly carriers exhibiting little or no evidence of efficacy. Genetic targeting of the β 1 -ΑR 389 polymorphism may improve the clinical responses to bucindolol for CV mortality and morbidity.

scholarly journals Adverse Outcome Prediction of Iron Deficiency in Patients with Acute Coronary Syndrome

Biomolecules ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. 60 ◽  
Author(s):  
Tanja Zeller ◽  
Christoph Waldeyer ◽  
Francisco Ojeda ◽  
Renate Schnabel ◽  
Sarina Schäfer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Iron Deficiency ◽  
Cardiovascular Mortality ◽  
Adverse Outcome ◽  
Smoking Status ◽  
Coronary Syndrome ◽  
Iron Deficient ◽  
Increased Risk

Acute myocardial infarction remains a leading cause of morbidity and mortality. While iron deficient heart failure patients are at increased risk of future cardiovascular events and see improvement with intravenous supplementation, the clinical relevance of iron deficiency in acute coronary syndrome remains unclear. We aimed to evaluate the prognostic value of iron deficiency in the acute coronary syndrome (ACS). Levels of ferritin, iron, and transferrin were measured at baseline in 836 patients with ACS. A total of 29.1% was categorized as iron deficient. The prevalence of iron deficiency was clearly higher in women (42.8%), and in patients with anemia (42.5%). During a median follow-up of 4.0 years, 111 subjects (13.3%) experienced non-fatal myocardial infarction (MI) and cardiovascular mortality as combined endpoint. Iron deficiency strongly predicted non-fatal MI and cardiovascular mortality with a hazard ratio (HR) of 1.52 (95% confidence interval (CI) 1.03-2.26; p = 0.037) adjusted for age, sex, hypertension, smoking status, diabetes, hyperlipidemia, body-mass-index (BMI) This association remained significant (HR 1.73 (95% CI 1.07–2.81; p = 0.026)) after an additional adjustment for surrogates of cardiac function and heart failure severity (N-terminal pro B-type natriuretic peptide, NT-proBNP), for the size of myocardial necrosis (troponin), and for anemia (hemoglobin). Survival analyses for cardiovascular mortality and MI provided further evidence for the prognostic relevance of iron deficiency (HR 1.50 (95% CI 1.02–2.20)). Our data showed that iron deficiency is strongly associated with adverse outcome in acute coronary syndrome.

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