Drugs
Comparative Effects of Pharmacological Treatment on Heart Failure with Mildly Reduced or Preserved Ejection Fraction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
By Zhang J, Wang Y, Li J and 5 others.
Abstract
Background
The comparative efficacy and safety of the new drugs (including sodium-glucose cotransporter-2 inhibitors [SGLT-2Is], glucagon-like peptide-1 receptor agonists [GLP-1RAs], non-steroidal mineralocorticoid receptor antagonists [nsMRAs], and soluble guanylate cyclase stimulators [sGCs]) for heart failure with mildly reduced or preserved (HFmrEF/HFpEF) ejection fraction remains largely unclear. We conducted a systematic review and network meta-analysis to evaluate their comparative effects on HFmrEF/HFpEF, aiming to provide evidence-based guidance for treatment selection.
Methods
MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were comprehensively searched. We included randomized controlled trials that compared nsMRA, sGC, SGLT-2I, and GLP-1RA with placebo for patients with HFmrEF/HFpEF. Primary efficacy outcomes were cardiovascular (CV) death, hospitalization for heart failure (HF hospitalization), and all-cause mortality, while primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs). The main analysis was conducted to compare the effects on HFmrEF/HFpEF between individual drugs. A frequentist network meta-analysis with random-effects models was used to calculate risk ratios (RRs) for dichotomous outcomes and standardized mean differences (SMDs) for continuous outcomes.