Abstract 16432: Optimal Dosing of ACE Inhibitors and ARBs in Chronic Heart Failure Patients - A Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Aaqib H Malik ◽  
Yasir Akram ◽  
Senada S Malik
Keyword(s):  
Heart Failure ◽  
Ace Inhibitors ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Mortality Benefit ◽  
Heart Failure Patients ◽  
Randomized Controlled ◽  
Optimal Dosing ◽  
Significant Mortality

Introduction: Congestive heart failure (CHF) is associated with significant morbidity and mortality. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are proven to be beneficial for improved survival and better quality of life in Heart failure patients. Optimal dosing of these agents presents a challenging question till date and controversy still surrounds whether similar health benefits can be achieved through lower dosages of ACE inhibitors and ARBs. Our aim was to determine whether there is a significant mortality benefit in CHF patients who receive higher dosage of ACE inhibitors and ARBs compared to lower dosage. Methods: Medline Indexed and Non-indexed, Cochrane Central, CINAHL and PsychINFO were searched for randomized controlled trials (RCTs) published till date. All RCTs that compared the clinical impact of high versus low dosage of ACE inhibitors or ARBs in heart failure patients were identified. Two independent investigators assessed the studies against an a priori inclusion criteria and disagreements were resolved by mutual discussion. Results: We used reported event rates for all studies to compute cumulative odds ratio and p-value for mortality. Summary effects were estimated using random effects models in RevMan 5.2. Of 1610 potentially relevant studies, a total of 5 studies (9027 patients) met our inclusion criteria and had data available on mortality events. The pooled estimate of the included studies showed a statistically significant 10% reduction in mortality of CHF patients who received higher dosage of ACE inhibitor and ARBs. (Odds Ratio: 0.90; 95% confidence interval 0.82,0.99). Heterogeneity was tested and it showed no evidence of publication bias. Conclusions: In conclusion, our meta-analysis of RCTs shows that higher dosage of ACE inhibitors and ARBs have a clinically and statistically significant mortality benefit over lower dosage in the management of chronic heart failure patients.

scholarly journals Temporal Trends and Clinical Trial Characteristics Associated With the Inclusion of Women in Heart Failure Trial Steering Committees: A Systematic Review

2021 ◽  
Author(s):  
Yousif Eliya ◽  
Sera Whitelaw ◽  
Lehana Thabane ◽  
Adriaan A. Voors ◽  
Pamela S. Douglas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Temporal Trends ◽  
The Self ◽  
Gender Composition ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Heart Failure Trial

Background: Trial steering committees (TSCs) steer the conduct of randomized controlled trials (RCTs). We examined the gender composition of TSCs in impactful heart failure RCTs and explored whether trial leadership by a woman was independently associated with the inclusion of women in TSCs. Methods: We systematically searched MEDLINE, EMBASE, and CINAHL for heart failure RCTs published in journals with impact factor ≥10 between January 2000 and May 2019. We used the Jonckheere-Terpstra test to assess temporal trends and multivariable logistic regression to explore trial characteristics associated with TSC inclusion of women. Results: Of 403 RCTs that met inclusion criteria, 127 (31.5%) reported having a TSC but 20 of these (15.7%) did not identify members. Among 107 TSCs that listed members, 56 (52.3%) included women and 6 of these (10.7%) restricted women members to the RCT leaders. Of 1213 TSC members, 11.1% (95% CI, 9.4%–13.0%) were women, with no change in temporal trends ( P =0.55). Women had greater odds of TSC inclusion in RCTs led by women (adjusted odds ratio, 2.48 [95% CI, 1.05–8.72], P =0.042); this association was nonsignificant when analysis excluded TSCs that restricted women to the RCT leaders (adjusted odds ratio 1.46 [95% CI, 0.43–4.91], P =0.36). Conclusions: Women were included in 52.3% of TSCs and represented 11.1% of TSC members in 107 heart failure RCTs, with no change in trends since 2000. RCTs led by women had higher adjusted odds of including women in TSCs, partly due to the self-inclusion of RCT leaders in TSCs.

Effect of home-based follow-up intervention on readmissions and mortality in heart failure patients: a meta-analysis

2019 ◽  
Vol 15 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Aaqib H Malik ◽  
Senada S Malik ◽  
Wilbert S Aronow ◽  
Keyword(s):  
Heart Failure ◽  
Discharge Planning ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Randomized Controlled ◽  
Home Based ◽  
Home Based Intervention ◽  
The Impact

Aim: We investigated whether the home-based intervention (HBI) for heart failure (HF), restricted to education and support, improves readmissions or mortality compared with usual care. Patients & methods: We searched PubMed and Embase for randomized controlled trials that examined the impact of HBI in HF. A random-effects meta-analysis was performed using R. Result: Total 17/409 articles (3214 patients) met our inclusion criteria. The pooled estimate showed HBI was associated with a reduction in readmission rates and mortality (22 and 16% respectively; p < 0.05). Subgroup analysis confirmed that the benefit of HBI increases significantly with a longer follow-up. Conclusion: HBI in the form of education and support significantly reduces readmission rates and improves survival of HF patients. HBI should be considered in the discharge planning of HF patients.

Abstract 18172: Rhythm Control with Catheter Ablation Improves Ejection Fraction Compared to Rate Control: A Meta-Analysis of Randomized Controlled Studies

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ajay Vallakati ◽  
Arun Kanmantha Reddy ◽  
Mark Dunlap ◽  
William Lewis
Keyword(s):  
Heart Failure ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Rate Control ◽  
Meta Analysis ◽  
Group Analysis ◽  
Rhythm Control ◽  
Significant Heterogeneity ◽  
Heart Failure Patients ◽  
Randomized Controlled

Background: Atrial fibrillation (AF) can exacerbate/worsen heart failure. A randomized study showed that rhythm control with anti-arrhythmic drugs (AADs) is not superior to rate control for heart failure patients who develop AF. However, a recent study revealed catheter ablation can improve the ejection fraction (EF) compared to medical rate control. Hypothesis: We performed a meta-analysis to compare the effect of rhythm control and medical rate control on EF in heart failure patients with AF. Methods: We searched PubMed, Embase, Google Scholar and Cochrane databases for all randomized controlled trials (RCTs) comparing rhythm control versus rate control for AF in heart failure. Primary outcome was change in EF. Random effects model was used to pool and analyze data across the studies. Results: Of a total of 7 RCTs (4 - AADs, 3 - catheter ablation) which compared rhythm control and medical rate control, 4 studies (n=202) reported quantitative data on EF. There was significant heterogeneity between the studies (I2=82%, p <0.001). Compared to rate control, the mean improvement in EF with rhythm control was 5.94% (95% CI 0.63- 11.26, p=0.03). Sub-group analysis revealed catheter ablation improved the EF by 6.67% (95% CI 0.23 -13.11, p=0.04) whereas rhythm control with AADs did not significantly change EF (3.50, -1.76 -8.76). Conclusion: Rhythm control is associated with greater improvement in EF compared to rate control therapy in heart failure patients with AF. Catheter ablation of AF significantly improves the EF in these patients. Further studies are needed to determine if this improvement in EF is associated with decreased morbidity and mortality.

Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure

2011 ◽  
Vol 19 (3) ◽  
pp. 428-435 ◽  
Author(s):  
NA Smart ◽  
T Meyer ◽  
JA Butterfield ◽  
SC Faddy ◽  
C Passino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Heart Failure Patients ◽  
Randomized Controlled

Background: Brain natriuretic peptide (BNP) predicts exercise performance and exercise training may modulate BNP and its N-terminal portion (NT-pro-BNP), we therefore conducted an individual patient analysis of exercise training effects on BNP and NT-pro-BNP. Aims: To use an individual patient meta-analysis to relate changes in BNP, NT-pro-BNP, and peak VO2; to link these changes to volume parameters of exercise training programmes (intensity etc.); and to identify patient characteristics likely to lead to greater improvements in BNP, NT-pro-BNP, and peak VO2. Design: Individual patient meta-analysis. Methods: A systematic search was conducted of Medline (Ovid), Embase.com, Cochrane Central Register of Controlled Trials, and CINAHL (until July 2008) to identify randomized controlled trials of aerobic and/or resistance exercise training in systolic heart failure patients measuring BNP and/or NT-pro-BNP. Primary outcome measures were change in BNP, NT-pro-BNP, and peak VO2. Subanalyses were conducted to identify (1) patient groups that benefit most and (2) exercise programme parameters enhancing favourable changes in primary outcome measures. Results: Ten randomized controlled studies measuring BNP or NT-pro-BNP met eligibility criteria, authors provided individual patient data for 565 patients (313 exercise and 252 controls). Exercise training had favourable effects on BNP (−28.3%, p < 0.0001), NT-pro-BNP (−37.4%, p =  < 0.0001), and peak VO2 (17.8%, p < 0.0001). The analysis showed a significant change in primary outcome measures; moreover, change in BNP ( r = −0.31, p < 0.0001) and NT-pro-BNP ( r = −0.22, p < 0.0001) were correlated with peak VO2 change. Conclusion: Exercise training has favourable effects on BNP, NT-pro-BNP, and peak VO2 in heart failure patients and BNP/NT-pro-BNP changes were correlated with peak VO2 changes.

scholarly journals Meta-Analysis of the Effects of Cardiac Rehabilitation on Exercise Tolerance and Cardiac Function in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Zhang-bing Chen ◽  
Liu-bo Fan ◽  
Ya-jing Liu ◽  
Ya-ru Zheng
Keyword(s):  
Heart Failure ◽  
Cardiac Function ◽  
Cardiac Rehabilitation ◽  
Exercise Tolerance ◽  
Meta Analysis ◽  
Cardiac Resynchronization ◽  
Control Group ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
Randomized Controlled

Objective. To evaluate the effects of cardiac rehabilitation on exercise tolerance and cardiac function in heart failure patients undergoing cardiac resynchronization therapy (CRT). Methods. Randomized controlled trials were initially identified from systematic reviews of the literature about cardiac rehabilitation and heart failure patients with CRT. We undertook updated literature searches of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CBM, CNKI, and Wanfang databases until July 1, 2017. STATA12.0 software was used. Results. Four randomized controlled studies were included. The total sample size was 157 patients, including 77 in the control group. Cardiac rehabilitation treatment affected the peak VO2 in heart failure patients with CRT (Pheterogeneity=0.491, I2 = 0%). The results lacked heterogeneity, and the data were merged in a fixed-effects model (WMD = 2.17 ml/kg/min, 95% CI (1.42, 2.92), P<0.001). The peak VO2 was significantly higher in the cardiac rehabilitation group than in the control group. The sensitivity analysis showed that the results of the meta-analysis were robust. Cardiac rehabilitation treatment affected LVEF in heart failure patients with CRT (Pheterogeneity=0.064, I2 = 63.6%); the heterogeneity among the various research results meant that the data were merged in a random-effects model (WMD = 4.75%, 95% CI (1.53, 7.97), P=0.004). The LVEF was significantly higher in the cardiac rehabilitation group than in the control group. The sources of heterogeneity were analyzed, and it was found that one of the studies was the source of significant heterogeneity. After the elimination of that study, the data were reanalyzed, and the heterogeneity was significantly reduced. There were still significant differences in the WMD and 95% CI. Conclusion. Cardiac rehabilitation can improve exercise tolerance and cardiac function in heart failure patients with CRT. Future studies are needed to evaluate whether these beneficial effects of cardiac rehabilitation may translate into an improvement in long-term clinical outcomes among these patients.

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