PMID- 30564701
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220330
IS  - 2398-3795 (Electronic)
IS  - 2398-3795 (Linking)
VI  - 2
IP  - 1
DP  - 2018 Apr
TI  - Are patients in heart failure trials representative of primary care populations? 
      A systematic review.
PG  - bjgpopen18X101337
LID - 10.3399/bjgpopen18X101337 [doi]
LID - bjgpopen18X101337
AB  - BACKGROUND: Guidelines recommend drug treatment for patients with heart failure 
      with a reduced ejection fraction (HFrEF), however the evidence for benefit in 
      patients with mild disease, such as most in primary care, is uncertain. 
      Importantly, drugs commonly used in heart failure account for one in seven of 
      emergency admissions for adverse drug reactions. AIM: To determine to what extent 
      patients included in studies of heart failure treatment with beta-blockers, 
      angiotensin-converting enzyme (ACE) inhibitors, and aldosterone antagonists were 
      representative of a typical primary care population with HFrEF in England. DESIGN 
      & SETTING: Systematic review of randomised controlled trials (RCTs) of drug 
      treatment in patients with HFrEF. METHOD: MEDLINE, MEDLINE In-Process, EMBASE, 
      and CENTRAL were searched from inception to March 2015. The characteristics of 
      the patient's New York Heart Association (NYHA) classification were compared with 
      a primary care reference population with HFrEF. RESULTS: Of the 30 studies 
      included, two had incomplete data. None had a close match (defined as </=10% 
      deviation from reference study) for NYHA class I disease; 5/28 were a close match 
      for NYHA class II; 5/28 for NYHA class III; and 18/28 for NYHA class IV. In 
      general, pre-existing cardiovascular conditions, risk factors, and comorbidities 
      were representative of the reference population. CONCLUSION: Patients recruited 
      to studies typically had more severe heart failure than the reference primary 
      care population. When evidence from sicker patients is generalised to less sick 
      people, there is increased uncertainty about benefit and also a risk of harm from 
      overtreatment. More evidence is needed on the effectiveness of treatment of heart 
      failure in asymptomatic patients with NYHA class I.
FAU - Gollop, Nicholas D
AU  - Gollop ND
AD  - MRC Clinical Research Fellow in Cardiology, Norwich Medical School, University of 
      East Anglia, Norwich, UK.
FAU - Ford, John
AU  - Ford J
AD  - NIHR Clinical Research Fellow, Norwich Medical School, University of East Anglia, 
      Norwich, UK.
FAU - Mackeith, Pieter
AU  - Mackeith P
AD  - Academic Clinical Fellow in Primary Care, Norwich Medical School, University of 
      East Anglia, Norwich, UK.
FAU - Thurlow, Caroline
AU  - Thurlow C
AD  - Academic Clinical Fellow in Primary Care, Norwich Medical School, University of 
      East Anglia, Norwich, UK.
FAU - Wakelin, Rachel
AU  - Wakelin R
AD  - Academic Clinical Fellow in Primary Care, Norwich Medical School, University of 
      East Anglia, Norwich, UK.
FAU - Steel, Nicholas
AU  - Steel N
AD  - Professor in Public Health, Norwich Medical School, University of East Anglia, 
      Norwich, UK.
FAU - Fleetcroft, Robert
AU  - Fleetcroft R
AD  - Honorary Senior Fellow, Norwich Medical School, University of East Anglia, 
      Norwich, UK.
LA  - eng
PT  - Journal Article
DEP - 20180424
PL  - England
TA  - BJGP Open
JT  - BJGP open
JID - 101713531
PMC - PMC6181083
OTO - NOTNLM
OT  - drug treatment
OT  - guidelines
OT  - heart failure
OT  - primary health care
COIS- The authors declare that no competing interests exist.
EDAT- 2018/12/20 06:00
MHDA- 2018/12/20 06:01
PMCR- 2018/04/24
CRDT- 2018/12/20 06:00
PHST- 2017/10/19 00:00 [received]
PHST- 2017/10/29 00:00 [accepted]
PHST- 2018/12/20 06:00 [entrez]
PHST- 2018/12/20 06:00 [pubmed]
PHST- 2018/12/20 06:01 [medline]
PHST- 2018/04/24 00:00 [pmc-release]
AID - 01337 [pii]
AID - 10.3399/bjgpopen18X101337 [doi]
PST - epublish
SO  - BJGP Open. 2018 Apr 24;2(1):bjgpopen18X101337. doi: 10.3399/bjgpopen18X101337. 
      eCollection 2018 Apr.