Abstract
Background: Heart failure (HF) with preserved ejection fraction (HFpEF) causes significant cardiovascular morbidity and mortality. It is a growing problem in the developed world, especially, in the aging population. There is a paucity of data on the treatment of patients with HFpEF. We aimed to identify pharmacotherapies that improve peak oxygen consumption (peak VO2), cardiovascular mortality, and HF hospitalizations in patients with HFpEF.Methods: We conducted a systematic literature search for English studies in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Google scholar. We searched databases using terms relating to or describing HFpEF, stage C HFpEF, and diastolic HF and included only randomized controlled trials (RCTs). RevMan 5.4 (The Cochrane Collaboration, 2020, London, UK) was used for data analysis, and two independent investigators performed literature retrieval and data-extraction. We used PRISMA guidelines to report the outcomes. We included 14 articles in our systematic review and six studies in meta-analysis.Results: We calculated the pooled mean difference (MD) of peak VO2 between placebo and pharmacotherapies. Our meta-analysis showed that the peak VO2 was comparable between pharmacotherapies and placebo in HFpEF (MD = 0.09, 95% CI: −0.11, 0.30, I2 =28%). Our systematic review highlights that statins and spironolactone use should be further studied in larger RCTs due to their potential beneficial effect on all-cause mortality and hospitalizations, respectively.Conclusion: Compared to placebo, none of the pharmacotherapies significantly improved peak VO2 in HFpEF except ivabradine. In our meta-analysis, the pooled improvement in peak VO2 is non-significant. This needs validation with larger studies. We are lacking larger studies on pharmacotherapies that improve peak VO2 in HFpEF. Statin and spironolactone should be further studied in patients with HFpEF as few trials have shown improvement in all-cause mortality and reduction in HF hospitalizations in selected patients, respectively.
Highlights
More than 6.2 million adults in the United States suffer from heart failure (HF) [1]
Statin and spironolactone should be further studied in patients with HF with preserved ejection fraction (HFpEF) as few trials have shown improvement in all-cause mortality and reduction in Heart failure (HF) hospitalizations in selected patients, respectively
A comprehensive literature search was performed on PubMed, Cochrane database, Embase, Google Scholar, and Web of Science identifying using relevant Medical Subject Headings (MeSH) and key word termed HFpEF (Heart Failure with Preserved Ejection Fraction) or HFnEF (Heart Failure with Normal Ejection Fraction) and “management,” “pharmacotherapy,” “future therapy,” “Neprilysin
Summary
More than 6.2 million adults in the United States suffer from heart failure (HF) [1]. HF with preserved ejection fraction (HFpEF) composes half of all patients with HF [2]. There is a paucity of data on newer pharmacotherapies in HFpEF. The aim of this analysis was to identify pharmacotherapies that improve peak oxygen consumption (peak VO2), cardiovascular mortality, and HF hospitalizations in patients with HFpEF. Heart failure (HF) with preserved ejection fraction (HFpEF) causes significant cardiovascular morbidity and mortality. It is a growing problem in the developed world, especially, in the aging population. We aimed to identify pharmacotherapies that improve peak oxygen consumption (peak VO2), cardiovascular mortality, and HF hospitalizations in patients with HFpEF
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