特定人群亚组中射血分数降低型心力衰竭的现代治疗方法的疗效：系统评价和网络荟萃分析。
Efficacy of Modern Therapies for Heart Failure with Reduced Ejection Fraction in Specific Population Subgroups: A Systematic Review and Network Meta-Analysis.
机构信息
Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Department of Nephrology and Dialysis, Azienda USL Roma 6, Rome, Italy.
出版信息
Cardiorenal Med. 2024;14(1):570-580. doi: 10.1159/000541393. Epub 2024 Sep 16.
INTRODUCTION
The efficacy and safety of emerging therapies for heart failure with reduced ejection fraction (HFrEF) have never been compared in specific subgroups of patients.
METHODS
PubMed, Cochrane Registry, Web of Science, Scopus, and EMBASE libraries were used to extract data. We used the following keywords: (heart failure with reduced ejection fraction OR HFrEF) AND (treatment OR therapy) OR (cardiovascular death) OR (hospitalization for heart failure). We compared randomized clinical trials for HFrEF emerging therapies focusing on the elderly (patients >65 years old and >75 years old), chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) < 60 mL/min), patients with diabetes mellitus (DM), coronary heart disease (CAD), New York Heart Association (NYHA) class III/IV, women, patients on sacubitril/valsartan (S/V). The primary outcome was the efficacy composite endpoint of cardiovascular death (CVD) and HF hospitalization (HFH).
RESULTS
S/V significantly reduced the primary outcome in patients >65 years old (RR: 0.80; 95% CI: 0.68-0.94) and with CKD (RR: 0.79; 95% CI: 0.69-0.90); dapagliflozin in patients >65 (RR: 0.72; 95% CI: 0.60-0.86) and >75 years old (RR: 0.68; 95% CI: 0.53-0.87), in those with CKD (RR: 0.72; 95% CI: 0.59-0.88), DM (RR: 0.75; 95% CI: 0.63-0.89), and CAD (RR: 0.77; 95% CI: 0.65-0.92); empagliflozin in patients >65 years old (RR: 0.78; 95% CI: 0.66-0.93), those with DM (RR: 0.72; 95% CI: 0.60-0.86), CAD (RR: 0.82; 95% CI: 0.68-0.99), women (RR: 0.59; 95% CI: 0.44-0.79), and in patients on S/V (RR: 0.64; 95% CI: 0.45-0.91); vericiguat in patients with CKD (RR: 0.84; 95% CI: 0.73-0.97) and NYHA class III/IV (RR: 0.87; 95% CI: 0.77-0.98); omecamtiv mecarbil in patients with CAD (RR: 0.90; 95% CI: 0.82-0.99) and NYHA III/IV (RR: 0.88; 95% CI: 0.80-0.97).
CONCLUSION
Emerging HFrEF therapies show a clinical benefit with the reduction of the primary composite endpoint of CVD and HFH, with each drug being more effective in specific patient population.
简介
新兴心力衰竭伴射血分数降低（HFrEF）疗法的疗效和安全性从未在特定患者亚组中进行比较。
方法
使用 PubMed、Cochrane 注册中心、Web of Science、Scopus 和 EMBASE 库提取数据。我们使用了以下关键词：（心力衰竭伴射血分数降低 OR HFrEF）和（治疗 OR 疗法）或（心血管死亡）或（心力衰竭住院）。我们比较了新兴 HFrEF 治疗的随机临床试验，重点关注老年人（患者年龄 >65 岁和 >75 岁）、慢性肾脏病（CKD）（估计肾小球滤过率（eGFR）<60 mL/min）、糖尿病患者（DM）、冠心病（CAD）、纽约心脏协会（NYHA）III/IV 级、女性、使用沙库巴曲缬沙坦（S/V）的患者。主要结局是心血管死亡（CVD）和心力衰竭住院（HFH）的复合疗效终点。
结果
S/V 显著降低了 >65 岁患者（RR：0.80；95%CI：0.68-0.94）和 CKD 患者（RR：0.79；95%CI：0.69-0.90）的主要结局；达格列净在 >65 岁患者（RR：0.72；95%CI：0.60-0.86）和 >75 岁患者（RR：0.68；95%CI：0.53-0.87）、CKD 患者（RR：0.72；95%CI：0.59-0.88）、DM 患者（RR：0.75；95%CI：0.63-0.89）和 CAD 患者（RR：0.77；95%CI：0.65-0.92）中降低了主要结局；恩格列净在 >65 岁患者（RR：0.78；95%CI：0.66-0.93）、DM 患者（RR：0.72；95%CI：0.60-0.86）、CAD 患者（RR：0.82；95%CI：0.68-0.99）、女性（RR：0.59；95%CI：0.44-0.79）和 S/V 治疗的患者（RR：0.64；95%CI：0.45-0.91）中降低了主要结局；维立西呱在 CKD 患者（RR：0.84；95%CI：0.73-0.97）和 NYHA III/IV 级患者（RR：0.87；95%CI：0.77-0.98）中降低了主要结局；奥马卡必利在 CAD 患者（RR：0.90；95%CI：0.82-0.99）和 NYHA III/IV 级患者（RR：0.88；95%CI：0.80-0.97）中降低了主要结局。
结论
新兴 HFrEF 疗法在降低 CVD 和 HFH 的主要复合终点方面显示出临床益处，每种药物在特定患者人群中更有效。
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