PMID- 26022990
OWN - NLM
STAT- MEDLINE
DCOM- 20150807
LR  - 20181202
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 31
IP  - 6
DP  - 2015 Jun
TI  - Baseline Functional Class and Therapeutic Efficacy of Common Heart Failure 
      Interventions: A Systematic Review and Meta-analysis.
PG  - 792-9
LID - S0828-282X(15)00021-5 [pii]
LID - 10.1016/j.cjca.2014.12.031 [doi]
AB  - BACKGROUND: New York Heart Association (NYHA) functional class provides important 
      prognostic information and is often used to select patients for cardiovascular 
      therapies, yet, the effect of NYHA class on therapeutic efficacy has not been 
      systematically studied. METHODS: In this systematic review and meta-analysis we 
      compared the relative and absolute mortality benefit of 5 common heart failure 
      interventions (angiotensin-converting enzyme [ACE] inhibitors, beta-blockers, 
      mineralocorticoid receptor antagonists [MRAs], implantable cardioverter 
      defibrillator [ICD], and cardiac resynchronization therapy [CRT]) across NYHA 
      class. We included 26 randomized clinical trials of these interventions that 
      reported all-cause mortality stratified according to baseline NYHA class in 
      36,406 patients. RESULTS: Pooled relative risk for NYHA I/II vs. III/IV strata 
      were similar for ACE inhibitors (0.90 vs. 0.88), beta-blockers (0.72 vs. 0.79), MRA 
      (0.79 vs. 0.75), and CRT (0.80 vs. 0.80), with all heterogeneity P > 0.8. 
      Conversely, ICD efficacy was greater for class I/II (relative risk, 0.65 vs 0.86, 
      heterogeneity P = 0.02). The pooled absolute risk difference was smaller for NYHA 
      I/II vs III/IV with ACE inhibitors (-0.02 vs. -0.06, P = 0.12), beta-blockers (-0.02 
      vs. -0.05, P = 0.047), MRA (-0.03 vs. -0.11, P = 0.001), and CRT (-0.01 vs. 
      -0.04, P = 0.036), but was similar across NYHA class for the ICD (-0.07 vs. 
      -0.05; P = 0.27). CONCLUSIONS: Relative mortality reductions with most 
      interventions were independent of baseline NYHA class. However, ICD efficacy was 
      greater with NYHA I/II vs. III/IV limitation, and absolute benefit was greater 
      with higher NYHA class. For interventions other than the ICD, there is little 
      evidence supporting use of NYHA class as a rigid criterion for selecting heart 
      failure therapies.
CI  - Copyright (c) 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All 
      rights reserved.
FAU - Miller, Robert J H
AU  - Miller RJ
AD  - Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, 
      Alberta, Canada.
FAU - Howlett, Jonathan G
AU  - Howlett JG
AD  - Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, 
      Alberta, Canada.
FAU - Exner, Derek V
AU  - Exner DV
AD  - Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, 
      Alberta, Canada.
FAU - Campbell, Patricia M
AU  - Campbell PM
AD  - Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, 
      Alberta, Canada.
FAU - Grant, Andrew D M
AU  - Grant AD
AD  - Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, 
      Alberta, Canada.
FAU - Wilton, Stephen B
AU  - Wilton SB
AD  - Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, 
      Alberta, Canada. Electronic address: sbwilton@ucalgary.ca.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20150107
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Mineralocorticoid Receptor Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Cardiac Pacing, Artificial/methods/mortality
MH  - Cardiac Resynchronization Therapy/*methods/mortality
MH  - *Cause of Death
MH  - Defibrillators, Implantable
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heart Failure/diagnosis/*mortality/*therapy
MH  - Humans
MH  - Male
MH  - Mineralocorticoid Receptor Antagonists/therapeutic use
MH  - Prognosis
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2015/05/30 06:00
MHDA- 2015/08/08 06:00
CRDT- 2015/05/30 06:00
PHST- 2014/11/18 00:00 [received]
PHST- 2014/12/27 00:00 [revised]
PHST- 2014/12/27 00:00 [accepted]
PHST- 2015/05/30 06:00 [entrez]
PHST- 2015/05/30 06:00 [pubmed]
PHST- 2015/08/08 06:00 [medline]
AID - S0828-282X(15)00021-5 [pii]
AID - 10.1016/j.cjca.2014.12.031 [doi]
PST - ppublish
SO  - Can J Cardiol. 2015 Jun;31(6):792-9. doi: 10.1016/j.cjca.2014.12.031. Epub 2015 
      Jan 7.