Meta-Analysis Evaluating the Effects of Renin-Angiotensin-Aldosterone System Blockade on Outcomes of Heart Failure With Preserved Ejection Fraction

John Bayhi — Sat, 14 Mar 2020 20:03:18 +0000

Date Added:

March 14, 2020

Journal/Publication:

The American Journal of Cardiology

Publisher:

Elsevier Inc.

Publication Date:

January 30, 2020

URL:

Meta-Analysis Evaluating the Effects of Renin-Angiotensin-Aldosterone System Blockade on Outcomes of Heart Failure With Preserved Ejection Fraction

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjcard.2020.01.009

Keywords

RAAS Anatgonists

heart failure

PMID (1):

32081366

ACEIs, ARBs, and spironolactone do not appear to reduce mortality or CHF hospitalizations in patients with CHF with preserved LV function. However, the combination of sacubitril (a neprilysin inhibitor) and valsartan may reduce CHF hospitalizations in those patients. James W. Mold, MD, MPH

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Clinical trials of renin-angiotensin-aldosterone system (RAAS) antagonists in heart failure with preserved ejection fraction (HFpEF) have suggested neutral results and treatment is focused on associated symptoms and comorbidities. MEDLINE and EMBASE were searched through October 2019 for randomized controlled studies investigating the effects of different RAAS antagonists in patients with HFpEF. The main outcomes were all-cause mortality, trial defined cardiovascular mortality, and heart failure (HF) hospitalizations. To compare different RAAS antagonists, a random-effects restricted-maximum-likelihood network meta-analysis based on a frequentist framework for indirect and mixed comparisons was used. We used p scores to rank best treatments per outcome. Our search identified 5 eligible clinical trials (PEP-CHF, perindopril; CHARM-preserved, candesartan; I-PRESERVE, irbesartan; TOPCAT, spironolactone; PARAGON-HF, sacubitril-valsartan and valsartan) enrolling a total 10,523 on RAAS antagonists and 6,259 controls. We did not identify any statistical difference in all-cause and cardiovascular mortality among RAAS antagonists and placebo. The combination of sacubitril-valsartan was associated with significantly decreased HF hospitalization risk compared with controls (odds ratio 0.73, 95% confidence interval 0.61 to 0.87) and angiotensin II receptor blockers (odds ratio 0.80, 95% confidence interval 0.71 to 0.91), without heterogeneity among studies (I2 = 0). Angiotensin receptor neprilysin inhibitor (ARNI) ranked better than other RAAS antagonists for HF hospitalizations (p value 0.9). In conclusion, RAAS antagonists do not affect mortality but the combination of sacubitril-valsartan is associated with lower HF hospitalizations in HFpEF patients.

Author/s:

Kuno, T, Ueyama, H, Fujisaki, T, Briasouli, A, Takagi, H, Briasoulis, A

Management of Heart Failure in 2019-2020, Part 1

Brian Desmarais — Fri, 03 Jan 2020 21:01:21 +0000

Date Added:

January 3, 2020

Journal/Publication:

JN Learning

Publisher:

JAMA

Publication Date:

September 1, 2016

URL:

Management of Heart Failure in 2019-2020, Part 1

Type:

Clinical Research Results

Format:

Video

Keywords

MeSH

Ventricular Remodeling

Aminobutyrates

Tetrazoles

Valsartan

This 16 min audiotape reviews the results of recent studies indicating that systolic CHF patients benefit from blocking an additional compensatory pathway, the neprilysin pathway, with the combination agent, sacubitril-valsartin if they remain symptomatic on an ACEI or ARB. James W. Mold, MD, MPH

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Educational Objective
To understand the effects of sacubitril-valsartan vs enalapril on proximal aortic stiffness, cardiac remodeling, and cardiac contractile function among patients with heart failure with reduced ejection fraction (HFrEF).

Author/s:

Desai, A.