PMID- 36473305
OWN - NLM
STAT- MEDLINE
DCOM- 20221227
LR  - 20230310
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 188
DP  - 2023 Feb 1
TI  - Meta-Analysis on Drug and Device Therapy of New York Heart Association Functional 
      Class IV Heart Failure With Reduced Ejection Fraction.
PG  - 52-60
LID - S0002-9149(22)01185-7 [pii]
LID - 10.1016/j.amjcard.2022.11.001 [doi]
AB  - Heart failure with reduced ejection fraction (HFrEF) is associated with 
      significant morbidity and mortality, particularly in patients with New York Heart 
      Association (NYHA) functional class IV symptoms. Decades of discovery have 
      heralded significant advancements in the pharmacologic management of HFrEF. 
      However, patients with NYHA IV symptoms remain an under-represented population in 
      almost every clinical trial to date, leaving clinicians with limited evidence 
      with which to guide drug treatment decisions in this patient group with severe 
      heart failure. Randomized controlled trials of adult patients with NYHA IV 
      symptoms of HFrEF randomized to current guideline-recommended medical therapy 
      were included in this systematic review and meta-analysis. The outcomes of 
      interest included the rate of all-cause mortality, cardiovascular mortality, and 
      heart failure hospitalization. A total of 39 randomized controlled trials were 
      included. A total of 6 studies examined angiotensin converting enzyme inhibitors, 
      with meta-analyses of 2 demonstrating a reduced risk of all-cause mortality 
      (relative risk (RR) 0.76, 95% confidence interval 0.59 to 0.97, p = 0.03). A 
      total of 11 studies examined beta blockers, with meta-analysis of 6 demonstrating a 
      reduced risk of all-cause mortality (risk ratio 0.74, 95% confidence interval 
      0.60 to 0.92, p = 0.008). A study examined the mineralocorticoid antagonist 
      spironolactone, reporting a reduced risk of all-cause mortality in the NYHA IV 
      subgroup. A total of 6 studies examined device therapy, demonstrating the benefit 
      of cardiac resynchronization therapy with or without an implantable cardiac 
      defibrillator in reducing hospitalization in the NYHA IV subgroup. Although trial 
      evidence exists for angiotensin converting enzyme inhibitors, beta-blockers, and 
      mineralocorticoid antagonist therapy in the NYHA IV population, the role of 
      angiotensin receptor blockers is unclear. Ivabradine, angiotensin receptor 
      neprilysin inhibitors, and sodium-glucose transport protein 2 inhibitors remain 
      underinvestigated and have not been proved to provide any benefit above standard 
      heart failure therapy in patients with HFrEF and NYHA IV symptoms.
CI  - Crown Copyright (c) 2022. Published by Elsevier Inc. All rights reserved.
FAU - Batchelor, Riley J
AU  - Batchelor RJ
AD  - Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public 
      Health and Preventive Medicine Monash University, Melbourne, Australia.
FAU - Nan Tie, Emilia
AU  - Nan Tie E
AD  - Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public 
      Health and Preventive Medicine Monash University, Melbourne, Australia.
FAU - Romero, Lorena
AU  - Romero L
AD  - The Ian Potter Library, Alfred Health, Melbourne, Australia.
FAU - Hopper, Ingrid
AU  - Hopper I
AD  - Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public 
      Health and Preventive Medicine Monash University, Melbourne, Australia.
FAU - Kaye, David M
AU  - Kaye DM
AD  - Department of Cardiology, Alfred Health, Melbourne, Australia; School of Public 
      Health and Preventive Medicine Monash University, Melbourne, Australia; Heart 
      Failure Research, Baker Heart and Diabetes Institute, Melbourne, Australia. 
      Electronic address: d.kaye@alfred.org.au.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20221205
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Mineralocorticoid Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin Receptor Antagonists)
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Heart Failure/drug therapy
MH  - Stroke Volume
MH  - Mineralocorticoid Receptor Antagonists/therapeutic use
MH  - New York
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Angiotensin Receptor Antagonists/therapeutic use
MH  - Randomized Controlled Trials as Topic
COIS- Disclosures The authors have no conflicts of interest to declare.
EDAT- 2022/12/07 06:00
MHDA- 2022/12/28 06:00
CRDT- 2022/12/06 18:16
PHST- 2022/08/18 00:00 [received]
PHST- 2022/10/28 00:00 [revised]
PHST- 2022/11/03 00:00 [accepted]
PHST- 2022/12/07 06:00 [pubmed]
PHST- 2022/12/28 06:00 [medline]
PHST- 2022/12/06 18:16 [entrez]
AID - S0002-9149(22)01185-7 [pii]
AID - 10.1016/j.amjcard.2022.11.001 [doi]
PST - ppublish
SO  - Am J Cardiol. 2023 Feb 1;188:52-60. doi: 10.1016/j.amjcard.2022.11.001. Epub 2022 
      Dec 5.