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Pharmacotherapy of heart failure with normal ejection fraction (HFNEF) – a systematic review
Author(s) -
Rajagopalan Sujit,
Arora Anjuman,
Shafiq Nusrat,
Reddy S Srinivas,
Pandhi Promila,
Mittal Niti,
Malhotra Samir
Publication year - 2011
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2011.03998.x
Subject(s) - ejection fraction , heart failure , medicine , pharmacotherapy , digoxin , cardiology , meta analysis , placebo , odds ratio , randomized controlled trial , confidence interval , alternative medicine , pathology
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The treatment options for heart failure with normal ejection fraction (HFNEF), which constitutes about 50% of the cases of heart failure, is varied and consists of β‐adrenoceptor blockers, angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), calcium channel blockers and digoxin. However none of the treatment options have shown consistent results in improving the condition. WHAT THIS STUDY ADDS • The meta‐analysis conducted by us on the pooled data from the clinical trials on the various treatment options has revealed no definite benefit with pharmacotherapy in HFNEF. A systematic review of these data reveals a possible benefit with β‐adrenoceptor blockers in this condition. But to evaluate this larger studies with preplanned subgroup analysis, longer follow up periods and with echocardiographic parameters as outcomes to measure the LV diastolic dysfunction are required. AIM The pharmacotherapy for heart failure with normal ejection fraction (HFNEF) is not as well defined as that for the treatment for heart failure with reduced ejection fraction (HFREF). Studies of the various drugs given for HFNEF have revealed conflicting results. The aim of this systematic review was to determine whether there is any benefit with pharmacotherapy in HFNEF in terms of cardiac outcomes. METHODS Electronic and printed sources were searched until August 2010 for randomized controlled clinical trials (RCTs) comparing drug therapy with placebo in HFNEF. Weighted mean difference and pooled odds ratio (OR) with 95% confidence intervals were calculated. RESULTS A total of six RCTs including 8410 patients with a mean follow‐up period of 21 months were included in the analysis. Although there were no significant differences in all cause mortality between the two groups (pooled OR 0.95, 95% CI 0.79, 1.13, P = 0.55), the subgroup analysis revealed a slight but non significant advantage with the β‐adrenoceptor blocker group. There was no significant difference between the two groups in terms of cardiovascular mortality, hospitalization, worsening heart failure, ejection fraction, E : A ratio, deceleration time and E : E′ ratio. CONCLUSION There was no significant benefit of pharmacotherapy in HFNEF. This might have been because of a lack of stringent inclusion criteria for patients in the trials and lower power of the studies. Hence trials with well defined inclusion criteria, better power, longer follow‐up periods and with echocardiographic parameters as endpoints are required to shed further light on this topic.