Efficacy and Safety of Different Combinations of Add-on Diuretic Therapy in Acute Heart Failure: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-08-26 DOI:10.1016/j.amjcard.2025.08.041

Andrew Sephien MD , Julia G Girgis BS , Tea Reljic MPH , Denisse Camille Dayto MD , Joanna M. Joly MD , Jason N. Katz MD, MHS , Jose A. Tallaj MD , Rosario A. Colombo MD , Athanasios Tsalatsanis PhD , Ambuj Kumar MD, MPH

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引用次数: 0

Abstract

Patients hospitalized with acute heart failure (HF) may experience diuretic resistance and require an add-on agent despite increasing loop diuretic dosage. While randomized controlled trials (RCTs) have compared add-on therapy to loop diuretics only, sparse literature exists on direct comparisons between various add-on therapies. We performed a systematic review and network meta-analysis of RCTs to assess the efficacy and safety of different diuretic add-on therapies in patients hospitalized with acute HF. Any RCT evaluating the effect of add-on diuretic therapy in patients hospitalized with acute HF was eligible for inclusion. A systematic search of EMBASE and PubMed was conducted until March 29, 2024. The primary outcome was the hospital length of stay. Data was pooled using a random-effects model for direct comparisons. A network meta-analysis using frequentist methods was performed under random-effects multiple treatment comparisons. We assessed ranking probability using the surface under the cumulative ranking curve (SUCRA) method. Of the 1,103 references, 29 RCTs enrolling 8,362 patients met the eligibility and were included. For the direct comparisons, there was no significant difference in hospital length of stay (MD -0.42, 95% CI= -0.87,0.02). Ranking probability based on SUCRA indicated that acetazolamide had the highest likelihood of being the best treatment for shorter hospital length of stay (SUCRA, 0.89), followed by SGLT2i (SUCRA, 0.70). The certainty of estimates for all outcomes ranged from moderate to very low.

In conclusion, the efficacy of add-on therapy was associated with reduced hospital length of stay. Albeit uncertain, the results from NMA provide initial evidence suggesting there may be optimal treatment strategies to decongest patients with HF to achieve and maintain euvolemia. However, well-designed direct comparison RCTs are needed to increase the certainty of the estimates. Protocol registered in PROSPERO (CRD42023476669).

查看原文本刊更多论文

急性心力衰竭不同联合利尿剂治疗的疗效和安全性：随机对照试验的系统评价和网络荟萃分析。

急性心力衰竭（HF）住院患者可能出现利尿剂抵抗，尽管增加利尿剂剂量，但仍需要添加利尿剂。虽然随机对照试验（rct）比较了附加治疗和循环利尿剂，但很少有文献直接比较各种附加治疗。我们对随机对照试验进行了系统回顾和网络荟萃分析，以评估急性心衰住院患者不同利尿剂附加治疗的疗效和安全性。任何评估急性心衰住院患者附加利尿剂治疗效果的RCT都符合纳入条件。EMBASE和PubMed的完整检索一直进行到2024年3月29日。主要观察指标为住院时间。数据采用随机效应模型进行直接比较。在随机效应多重治疗比较下，使用频率论方法进行网络荟萃分析。我们用累积排序曲线（SUCRA）下的曲面来评估排序概率。在1103篇参考文献中，29项随机对照试验纳入8,362例患者，符合入选条件。直接比较，住院时间差异无统计学意义（MD = -0.42, 95% CI= -0.87,0.02）。基于SUCRA的排序概率表明，乙酰唑胺最有可能成为较短住院时间的最佳治疗方法（SUCRA, 0.89），其次是SGLT2i （SUCRA, 0.70）。所有结果估计的确定性范围从中等到非常低。总之，附加治疗的疗效与缩短住院时间有关。尽管不确定，但NMA的结果提供了初步证据，表明可能存在最佳的治疗策略来减少心力衰竭患者的充血，以达到并维持血液充血。然而，需要设计良好的直接比较随机对照试验来增加估计的确定性。在PROSPERO中注册的协议（CRD42023476669）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.