PMID- 34283990
OWN - NLM
STAT- MEDLINE
DCOM- 20211021
LR  - 20211021
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 241
DP  - 2021 Nov
TI  - Impact of oral soluble guanylate cyclase stimulators in heart failure: A 
      systematic review and Meta-analysis of randomized controlled trials.
PG  - 74-82
LID - S0002-8703(21)00182-4 [pii]
LID - 10.1016/j.ahj.2021.07.003 [doi]
AB  - BACKGROUND: Soluble guanylate cyclase (sGC) stimulators are a novel class of 
      medications with emerging role in heart failure (HF). The aim of this study is to 
      evaluate the efficacy and safety of oral sGC stimulators in patients with HF with 
      reduced and preserved ejection fraction (HFrEF and HFpEF) by pooling data from 
      all available randomized control trials (RCT). METHODS: A comprehensive search of 
      electronic databases from 2000-2020 was performed. Seven RCTs, three HFrEF and 
      four HFpEF studies, were identified. The follow-up duration ranged from 1 month 
      to a median of 10.8 months. A random-effects meta-analysis was conducted to 
      summarize the studies. RESULTS: The study population included 7190 patients: 5707 
      HFrEF and 1483 HFpEF patients. In HFrEF, oral sGC stimulators reduced the 
      composite incidence of HF hospitalization and cardiovascular death (hazard ratio 
      [HR] 0.87, 95% confidence interval [CI] 0.78-0.97; I(2) = 0%), primarily driven 
      by lower HF hospitalization (HR 0.88, 95% CI 0.78-0.99; I(2) = 0%). There was no 
      significant reduction in all-cause death in HFrEF (HR 0.95, 95% CI 0.83-1.09; 
      I(2) = 0%). In HFpEF, there were no improvements in Kansas City Cardiomyopathy 
      Questionnaire clinical summary scores (mean difference 0.81, 95% CI -2.16-3.77; 
      I(2) = 72%) or 6-minute walk distance (mean difference 3.34 meters, 95% CI 
      -7.86-14.54; I(2) = 28%). There was no difference in all-cause mortality in HFpEF 
      (HR 1.94, 95% CI 0.92-4.09; I(2) = 0%). Overall, oral sGC stimulators had low 
      medication-related serious adverse events. CONCLUSION: Oral sGC stimulators are 
      well tolerated in HF and reduce the incidence of HF hospitalization but not 
      cardiovascular death among patients with HFrEF. However, there are no apparent 
      benefits in HFpEF.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Moghaddam, Nima
AU  - Moghaddam N
AD  - Department of Medicine, Division of Cardiology, University of British Columbia, 
      Vancouver, Canada.
FAU - Malhi, Navraj
AU  - Malhi N
AD  - Department of Medicine, Division of Cardiology, University of British Columbia, 
      Vancouver, Canada.
FAU - Toma, Mustafa
AU  - Toma M
AD  - Department of Medicine, Division of Cardiology, University of British Columbia, 
      Vancouver, Canada; St. Paul's Hospital, Providence Health Care, Vancouver, 
      Canada. Electronic address: mtoma@providencehealth.bc.ca.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210718
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Enzyme Activators)
RN  - EC 4.6.1.2 (Soluble Guanylyl Cyclase)
SB  - IM
MH  - Enzyme Activators/*pharmacology
MH  - *Heart Failure/drug therapy/metabolism/mortality
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Mortality
MH  - Randomized Controlled Trials as Topic
MH  - Soluble Guanylyl Cyclase/*metabolism
EDAT- 2021/07/21 06:00
MHDA- 2023/02/25 06:00
CRDT- 2021/07/20 20:10
PHST- 2021/02/04 00:00 [received]
PHST- 2021/07/08 00:00 [accepted]
PHST- 2021/07/21 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2021/07/20 20:10 [entrez]
AID - S0002-8703(21)00182-4 [pii]
AID - 10.1016/j.ahj.2021.07.003 [doi]
PST - ppublish
SO  - Am Heart J. 2021 Nov;241:74-82. doi: 10.1016/j.ahj.2021.07.003. Epub 2021 Jul 18.