Greg Moore Professorship in Clinical & Community Cardiovascular Pharmacy, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
St. Paul's Hospital, Vancouver, Canada.
Eur J Heart Fail. 2021 Apr;23(4):578-589. doi: 10.1002/ejhf.2141. Epub 2021 Mar 9.
The aim of this study was to synthesize the evidence on the effect of heart failure with reduced ejection fraction (HFrEF) pharmacotherapy on health-related quality of life (HRQoL).
We searched MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform in June 2020. Randomized placebo-controlled trials evaluating contemporary HFrEF pharmacotherapy and reporting HRQoL as an outcome were included. Two reviewers independently assessed studies for eligibility, extracted data, and assessed risk of bias and GRADE certainty of evidence. The primary outcome was HRQoL at last available follow-up analysed using a random-effects model. We included 37 studies from 5770 identified articles. Risk of bias was low in 10 trials and high/unclear in 27 trials. High certainty evidence from meta-analyses demonstrated improved HRQoL over placebo with sodium-glucose co-transporter 2 (SGLT2) inhibitors [standardized mean difference (SMD) 0.16, 95% confidence interval (CI) 0.08-0.23] and intravenous iron (SMD 0.52, 95% CI 0.04-1.00). Furthermore, high certainty evidence from ≥1 landmark trial further supported improved HRQoL with angiotensin receptor blockers (ARBs) (SMD 0.09, 95% CI 0.02-0.17), ivabradine (SMD 0.14, 95% CI 0.04-0.23), hydralazine-nitrate (SMD 0.24, 95% CI 0.04-0.44) vs. placebo, and for angiotensin receptor-neprilysin inhibitor (ARNI) compared with an angiotensin-converting enzyme (ACE) inhibitor (SMD 0.09, 95% CI 0.02-0.17). Findings were inconclusive for ACE inhibitors, beta-blockers, digoxin, and oral iron based on low-to-moderate certainty evidence.
ARBs, ARNIs, SGLT2 inhibitors, ivabradine, hydralazine-nitrate, and intravenous iron improved HRQoL in patients with HFrEF. These findings can be incorporated into discussions with patients to enable shared decision-making.
本研究旨在综合心力衰竭伴射血分数降低（HFrEF）药物治疗对健康相关生活质量（HRQoL）影响的证据。
我们于 2020 年 6 月检索了 MEDLINE、Embase、CENTRAL、CINAHL、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台。纳入评估当代 HFrEF 药物治疗并将 HRQoL 作为结局指标的随机安慰剂对照试验。两名审查员独立评估研究的入选情况、提取数据，并评估偏倚风险和 GRADE 证据确定性。主要结局指标为最后一次随访时的 HRQoL，采用随机效应模型进行分析。我们纳入了从 5770 篇已识别文章中筛选出的 37 项研究。10 项试验的偏倚风险较低，27 项试验的偏倚风险较高/不明确。荟萃分析的高确定性证据表明，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂[标准化均数差（SMD）0.16，95%置信区间（CI）0.08-0.23]和静脉铁剂（SMD 0.52，95%CI 0.04-1.00）治疗可改善 HRQoL 优于安慰剂。此外，至少有 1 项标志性试验的高确定性证据进一步支持血管紧张素受体阻滞剂（ARBs）[SMD 0.09，95%CI 0.02-0.17]、伊伐布雷定[SMD 0.14，95%CI 0.04-0.23]、肼屈嗪-硝酸盐[SMD 0.24，95%CI 0.04-0.44]治疗可改善 HRQoL 优于安慰剂，血管紧张素受体-脑啡肽酶抑制剂（ARNI）与血管紧张素转换酶（ACE）抑制剂相比可改善 HRQoL[SMD 0.09，95%CI 0.02-0.17]。基于低到中等确定性证据，ACE 抑制剂、β受体阻滞剂、地高辛和口服铁剂的结果不确定。
ARBs、ARNI、SGLT2 抑制剂、伊伐布雷定、肼屈嗪-硝酸盐和静脉铁剂可改善 HFrEF 患者的 HRQoL。这些发现可以纳入与患者的讨论中，以实现共同决策。
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