Network Meta-Analysis of Quality of Life in Heart Failure With Reduced Ejection Fraction.

IF 8.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2025-09-05 DOI:10.1161/CIRCHEARTFAILURE.125.013074

Robert Margaryan, Nariman Sepehrvand, Wouter Ouwerkerk, Jasper Tromp, Ricky D Turgeon, Justin A Ezekowitz

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引用次数: 0

Abstract

Background: Although the effects of various combinations of treatments on mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) have been evaluated, the impact on quality of life is unknown. This study evaluated and compared the composite impact of pharmacological therapies on quality of life in HFrEF using a frequentist network meta-analysis and systematic review methodology.

Methods: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials published between January 1, 2021 and August 10, 2024. We included all contemporary and efficacious HFrEF therapies used in adults. The primary outcome was change in quality of life measured through the Kansas City Cardiomyopathy Questionnaire and the Minnesota Living with Heart Failure Questionnaire, expressed as mean difference (MD).

Results: We identified 41 randomized controlled trials representing 41 145 patients (76.5% male). The trials had a median of 276 participants (105-464), a mean left ventricular ejection fraction of 28%, and a median follow-up time of 5 months (3-8). A combination of angiotensin receptor blocker/neprilysin inhibitors (ARNi)+β-blockers (BB)+sodium-glucose cotransporter 2 inhibitors (SGLT2i; MD, +5.3 [+0.4, +10.3]) was the most effective at improving quality of life followed by ARNi+BB+mineralocorticoid receptor antagonists (MRA)+SGLT2i (MD, +7.1 [-1.0 to +15.2]), ACE inhibitor+BB+MRA+SGLT2i (MD, +5.3 [-2.6, to +13.3]), and ACE inhibitor+BB+MRA+ivabradine (MD, +5.2 [-3.1 to +13.6]), which were not statistically significant. Individually, the most effective treatments for improving quality of life were SGLT2i (MD, +3.4 [+1.4 to +5.30]), ivabradine (MD, +3.3 [+0.1 to +6.4]), ARNi (MD, +2.6 [-3.2 to +8.5]), and MRA (MD, +1.8 [-4.8 to +8.4]).

Conclusions: A composite of ARNi+BB+SGLT2i or ARNi+BB+MRA+SGLT2i was the most effective at improving quality of life in patients with HFrEF.

查看原文本刊更多论文

心力衰竭伴射血分数降低患者生活质量的网络meta分析。

背景：虽然已经评估了各种治疗组合对心力衰竭伴射血分数降低（HFrEF）患者死亡率和发病率的影响，但对生活质量的影响尚不清楚。本研究使用频率网络荟萃分析和系统回顾方法评估和比较了药物治疗对HFrEF患者生活质量的综合影响。方法：检索MEDLINE、EMBASE和Cochrane中央对照试验注册库，检索2021年1月1日至2024年8月10日发表的随机对照试验。我们纳入了所有当代有效的成人HFrEF治疗方法。主要结局是通过堪萨斯城心肌病问卷和明尼苏达州心衰生活问卷测量的生活质量变化，以平均差异（MD）表示。结果：我们纳入了41项随机对照试验，涉及41 145例患者（76.5%为男性）。试验中位数为276名参与者（105-464），平均左心室射血分数为28%，中位随访时间为5个月（3-8）。血管紧张素受体阻滞剂/neprilysin抑制剂(ARNi)+β受体阻滞剂(BB)+钠-葡萄糖共转运蛋白2抑制剂（SGLT2i； MD, +5.3[+0.4, +10.3]）联合治疗对改善生活质量最有效，其次是ARNi+BB+盐皮质激素受体拮抗剂(MRA)+SGLT2i (MD, +7.1[-1.0至+15.2])，ACE抑制剂+BB+MRA+SGLT2i (MD, +5.3[-2.6，至+13.3])，ACE抑制剂+BB+MRA+伊伐布雷定（MD, +5.2[-3.1至+13.6]），差异无统计学意义。单独而言，改善生活质量最有效的治疗方法是SGLT2i (MD, +3.4[+1.4至+5.30])，伊伐布雷定（MD, +3.3[+0.1至+6.4]），ARNi （MD, +2.6[-3.2至+8.5]）和MRA （MD, +1.8[-4.8至+8.4]）。结论：ARNi+BB+SGLT2i或ARNi+BB+MRA+SGLT2i的组合对改善HFrEF患者的生活质量最有效。

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

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.