Blockade of the neurohormonal systems in heart failure with preserved ejection fraction: A contemporary meta-analysis

Although individual studies failed to demonstrate significant benefits with neurohormonal inhibitors in patients affected by heart failure (HF) with preserved ejection fraction (HFpEF), an evident trend towards a reduction in hospitalization and mortality has been previously documented in most cases...

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Bibliographic Details
Published in:International journal of cardiology 2020-10, Vol.316, p.172-179
Main Authors: Gallo, Giovanna, Tocci, Giuliano, Fogacci, Federica, Battistoni, Allegra, Rubattu, Speranza, Volpe, Massimo
Format: Article
Language:English
Subjects:
Heart Failure - diagnosis
Heart Failure - drug therapy
Heart failure with preserved ejection fraction
Hospitalization
Humans
Meta-analysis
Neurohormonal inhibitors
Renin-Angiotensin System
Stroke Volume
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Summary:Although individual studies failed to demonstrate significant benefits with neurohormonal inhibitors in patients affected by heart failure (HF) with preserved ejection fraction (HFpEF), an evident trend towards a reduction in hospitalization and mortality has been previously documented in most cases. We aimed to conduct an updated meta-analysis on the effect of neurohormonal inhibitors [renin-angiotensin-aldosterone system (RAAS) inhibitors and angiotensin receptor neprilysin inhibitors (ARNi)] on the primary composite outcome of mortality and hospitalizations for HF and on the secondary outcomes of mortality and hospitalizations separately analyzed. The extended literature search ended up with the identification of a total of 12 studies cumulatively including 30,882 patients, 16,540 in the treatment and 14,432 in the control groups. Eleven studies explored the outcome of death, 9 studies reported data about HF hospitalizations and 8 studies explored the composite outcome of death and HF hospitalizations. Our meta-analysis showed that treatment with neurohormonal inhibitors was significantly associated with a reduced risk of the primary composite outcome (OR 0.87, 95%CI: 0.82–0.93, p 
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2020.05.084