Decades of data help researchers recommend the optimal HFrEF treatment

After reviewing decades of data from nearly 100,000 patients, a team of researchers believes they have identified the optimal pharmacological treatment for heart failure with reduced ejection fraction (HFrEF). The group shared its findings in JACC: Heart Failure.

The analysis focused on data from 75 randomized controlled trials that included 95,444 patients. Sixty-seven percent of patients were men, and the median follow-up duration was 11 months. The 75 studies were all published from 1987 to 2020. 

The study's primary outcome was all-cause death. Overall, the authors found that a combination of angiotensin receptor–neprilysin inhibitors (ARNi) and mineralocorticoid receptor antagonists (MRA) was associated with the largest decline in all-cause death, followed by beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi) sodium-glucose cotransporter 2 inhibitors (SGLT2i) and angiotensin receptor blocker (ARB).

In addition, MRA was associated with the largest reduction in the composite outcome of cardiovascular death and hospitalization for heart failure or CV death alone, followed by SGLT2i.

Life years gained at the age of 70 on ARNi, BB, MRA, and SGLT2i was 5.0 years.

“Results of this study support the concept of treating patients with a combination of ARNi, BB, MRA, and SGLT2i as first choice therapy, and highlight its significant benefit,” wrote lead author Jasper Tromp, MD, PHD, of the University of Groningen in the Netherlands, and colleagues. “Current guidelines for HF recommend starting with ACEi/ARB as first-line treatment. In our analyses, ARNi showed a smaller hazard ration for all-cause mortality than ACEi/ARB and a lower risk for discontinuation compared with placebo. Therefore, our results support starting with ARNi as first-line therapy rather than ACEi or ARB."

Read the full study here.

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