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Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction: A Network Meta-Analysis.

Abstract Treatments that reduce mortality and morbidity in patients with heart failure with reduced ejection fraction, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), β-blockers (BB), mineralocorticoid receptor antagonists (MRA), and angiotensin receptor-neprilysin inhibitors (ARNI), have not been studied in a head-to-head fashion. This network meta-analysis aimed to compare the efficacy of these drugs and their combinations regarding all-cause mortality in patients with heart failure with reduced ejection fraction.
PMID
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Authors

Mayor MeshTerms
Keywords

drug combinations

drug therapy

heart failure

mortality

network meta-analysis

Journal Title circulation. heart failure
Publication Year Start




PMID- 28087688
OWN - NLM
STAT- In-Data-Review
DA  - 20170114
LR  - 20170114
IS  - 1941-3297 (Electronic)
IS  - 1941-3289 (Linking)
VI  - 10
IP  - 1
DP  - 2017 Jan
TI  - Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart
      Failure With Reduced Ejection Fraction: A Network Meta-Analysis.
LID - e003529 [pii]
LID - 10.1161/CIRCHEARTFAILURE.116.003529 [doi]
AB  - BACKGROUND: Treatments that reduce mortality and morbidity in patients with heart
      failure with reduced ejection fraction, including angiotensin-converting enzyme
      inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (BB),
      mineralocorticoid receptor antagonists (MRA), and angiotensin receptor-neprilysin
      inhibitors (ARNI), have not been studied in a head-to-head fashion. This network 
      meta-analysis aimed to compare the efficacy of these drugs and their combinations
      regarding all-cause mortality in patients with heart failure with reduced
      ejection fraction. METHODS AND RESULTS: A systematic literature review identified
      57 randomized controlled trials published between 1987 and 2015, which were
      compared in terms of study and patient characteristics, baseline risk, outcome
      definitions, and the observed treatment effects. Despite differences identified
      in terms of study duration, New York Heart Association class, ejection fraction, 
      and use of background digoxin, a network meta-analysis was considered feasible
      and all trials were analyzed simultaneously. The random-effects network
      meta-analysis suggested that the combination of ACEI+BB+MRA was associated with a
      56% reduction in mortality versus placebo (hazard ratio 0.44, 95% credible
      interval 0.26-0.66); ARNI+BB+MRA was associated with the greatest reduction in
      all-cause mortality versus placebo (hazard ratio 0.37, 95% credible interval
      0.19-0.65). A sensitivity analysis that did not account for background therapy
      suggested that ARNI monotherapy is more efficacious than ACEI or ARB monotherapy.
      CONCLUSIONS: The network meta-analysis showed that treatment with ACEI, ARB, BB, 
      MRA, and ARNI and their combinations were better than the treatment with placebo 
      in reducing all-cause mortality, with the exception of ARB monotherapy and ARB
      plus ACEI. The combination of ARNI+BB+MRA resulted in the greatest mortality
      reduction.
CI  - (c) 2017 The Authors.
FAU - Burnett, Heather
AU  - Burnett H
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
      [email protected]
FAU - Earley, Amy
AU  - Earley A
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
FAU - Voors, Adriaan A
AU  - Voors AA
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
FAU - Senni, Michele
AU  - Senni M
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
FAU - McMurray, John J V
AU  - McMurray JJ
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
FAU - Deschaseaux, Celine
AU  - Deschaseaux C
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
FAU - Cope, Shannon
AU  - Cope S
AD  - From the Mapi, Health Economics and Outcomes Research, Dundas, Canada (H.B.);
      Mapi, Health Economics and Outcomes Research, Boston, MA (A.E.); Department of
      Cardiology, University of Groningen, The Netherlands (A.A.V.); Cardiovascular
      Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.); British Heart
      Foundation Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M.); 
      Global Patient Access, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland
      (C.D.); and Mapi, Health Economics and Outcomes Research, Toronto, Canada (S.C.).
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circ Heart Fail
JT  - Circulation. Heart failure
JID - 101479941
OTO - NOTNLM
OT  - drug combinations
OT  - drug therapy
OT  - heart failure
OT  - mortality
OT  - network meta-analysis
EDAT- 2017/01/15 06:00
MHDA- 2017/01/15 06:00
CRDT- 2017/01/15 06:00
PHST- 2016/08/23 [received]
PHST- 2016/12/15 [accepted]
AID - CIRCHEARTFAILURE.116.003529 [pii]
AID - 10.1161/CIRCHEARTFAILURE.116.003529 [doi]
PST - ppublish
SO  - Circ Heart Fail. 2017 Jan;10(1). pii: e003529. doi:
      10.1161/CIRCHEARTFAILURE.116.003529.

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