Meta-Analysis on Drug and Device Therapy of New York Heart Association Functional Class IV Heart Failure With Reduced Ejection Fraction
Section snippets
Methods
This systematic review and meta-analysis was conducted in accordance to the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.23 Systematic searches of the electronic databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were conducted, identifying articles from inception to March 2022. A health service librarian with expertise in conducting systematic reviews was engaged in developing the search strategy (LR). The
Results
This systematic search identified 7,988 unique studies, of which 7,570 were excluded based on title or abstract screening. The remaining 418 studies were eligible for full-text review, after which a further 379 studies were excluded, leaving 39 studies included in this systematic review. The most common reason for study exclusion at full-text screen was a study population that did not include patients with NYHA functional class IV symptoms (n = 213 studies). The screening process and all
Discussion
This large systematic review is the only study to compare and pool the results of RCTs examining heart failure therapy in patients with NYHA IV symptoms of HFrEF. A qualitative review of 4 ACEi trials with a meta-analysis of 2 trials found a reduction in all-cause mortality with ACEi therapy versus best medical therapy of the 1,980 to 1,990 seconds (hydralazine, nitrates, digoxin) in the NYHA IV subgroup. A qualitative review of 8 trials randomizing ARB versus placebo or ACEi were inconclusive
Disclosures
The authors have no conflicts of interest to declare.
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The role and application of current pharmacological management in patients with advanced heart failure
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Drs. Riley J Batchelor& Emilia Nan Tie contributed equally as first authors.
Funding: None.
- 1
These authors contributed equally.