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Abstract
Acute heart failure remains a common and ominous clinical condition. Several interventions are currently available, with ensuing difficulties in prioritizing and formalizing decision-making. Network meta-analysis appears particularly promising to summarize the evidence base on competing interventions. We thus aimed to review, appraise, and summarize recent network meta-analyses on acute heart failure care. We searched for recent network meta-analyses on acute heart failure care, retrieving five reviews, encompassing a total of 101 randomized trials and 19,085 patients. Three reviews focused on severe sepsis or septic shock, one review on shock-refractory ventricular arrhythmias, and one review on high-risk percutaneous coronary intervention. Quality of reporting and internal validity of the reviews was moderate, with common shortcomings on protocol registration and confounding appraisal. No single intervention or combo proved clearly superior for severe sepsis or septic shock, lidocaine appeared as the best strategy for shock-refractory ventricular arrhythmias, and medical therapy appeared most favorable for high-risk percutaneous coronary intervention. Recent network meta-analyses on acute heart failure begin to offer guidance for comparative effectiveness and improved clinical decision-making. Further synthesizing efforts are however needed to provide a more comprehensive and updated synthesis of the multitude of clinical alternatives for physicians caring for patients with acute heart failure.
Published Version
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