Efficacy of Modern Therapies for Heart Failure with Reduced Ejection Fraction in Specific Population Subgroups: A Systematic Review and Network Meta-Analysis

Cardiorenal Med. 2024;14(1):570-580. doi: 10.1159/000541393. Epub 2024 Sep 16.

Abstract

Introduction: The efficacy and safety of emerging therapies for heart failure with reduced ejection fraction (HFrEF) have never been compared in specific subgroups of patients.

Methods: PubMed, Cochrane Registry, Web of Science, Scopus, and EMBASE libraries were used to extract data. We used the following keywords: (heart failure with reduced ejection fraction OR HFrEF) AND (treatment OR therapy) OR (cardiovascular death) OR (hospitalization for heart failure). We compared randomized clinical trials for HFrEF emerging therapies focusing on the elderly (patients >65 years old and >75 years old), chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) < 60 mL/min), patients with diabetes mellitus (DM), coronary heart disease (CAD), New York Heart Association (NYHA) class III/IV, women, patients on sacubitril/valsartan (S/V). The primary outcome was the efficacy composite endpoint of cardiovascular death (CVD) and HF hospitalization (HFH).

Results: S/V significantly reduced the primary outcome in patients >65 years old (RR: 0.80; 95% CI: 0.68-0.94) and with CKD (RR: 0.79; 95% CI: 0.69-0.90); dapagliflozin in patients >65 (RR: 0.72; 95% CI: 0.60-0.86) and >75 years old (RR: 0.68; 95% CI: 0.53-0.87), in those with CKD (RR: 0.72; 95% CI: 0.59-0.88), DM (RR: 0.75; 95% CI: 0.63-0.89), and CAD (RR: 0.77; 95% CI: 0.65-0.92); empagliflozin in patients >65 years old (RR: 0.78; 95% CI: 0.66-0.93), those with DM (RR: 0.72; 95% CI: 0.60-0.86), CAD (RR: 0.82; 95% CI: 0.68-0.99), women (RR: 0.59; 95% CI: 0.44-0.79), and in patients on S/V (RR: 0.64; 95% CI: 0.45-0.91); vericiguat in patients with CKD (RR: 0.84; 95% CI: 0.73-0.97) and NYHA class III/IV (RR: 0.87; 95% CI: 0.77-0.98); omecamtiv mecarbil in patients with CAD (RR: 0.90; 95% CI: 0.82-0.99) and NYHA III/IV (RR: 0.88; 95% CI: 0.80-0.97).

Conclusion: Emerging HFrEF therapies show a clinical benefit with the reduction of the primary composite endpoint of CVD and HFH, with each drug being more effective in specific patient population.

Keywords: Cardiovascular death; Heart failure with reduced ejection fraction; Hospitalization for heart failure; Meta-analysis; Treatment.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Aged
  • Aminobutyrates* / therapeutic use
  • Angiotensin Receptor Antagonists / therapeutic use
  • Biphenyl Compounds / therapeutic use
  • Drug Combinations
  • Female
  • Glomerular Filtration Rate / physiology
  • Heart Failure* / drug therapy
  • Heart Failure* / etiology
  • Heart Failure* / physiopathology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Network Meta-Analysis
  • Randomized Controlled Trials as Topic
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use
  • Stroke Volume* / physiology
  • Treatment Outcome
  • Valsartan / therapeutic use

Substances

  • Aminobutyrates
  • Angiotensin Receptor Antagonists
  • Biphenyl Compounds
  • Drug Combinations
  • sacubitril and valsartan sodium hydrate drug combination
  • Sodium-Glucose Transporter 2 Inhibitors
  • Valsartan