Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
SGLT2 inhibitors optimal drug class for heart failure with preserved and mildly reduced ejection fraction
Clinical Question
What drug classes are optimal for the management of adults with heart failure with preserved ejection fraction and mildly reduced ejection fraction?
Bottom line
This network meta-analysis found that the optimal medications for reducing hospital admissions among adults with preserved ejection fraction and mildly reduced ejection fraction are the SGLT2 inhibitors. No drug class, including SGLT2 inhibitors, reduced the risk of cardiovascular or all-cause death. ARNIs (eg, sacubitril/valsartan) and MRAs (eg, spironolactone, eplerenone) were also associated with a reduced risk of hospitalization for HF. Current evidence does not support an independent benefit of ACE inhibitors, ARBs, or beta-blockers. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
These investigators thoroughly searched multiple databases, including PubMed, EMBASE, and the Cochrane Register, for randomized trials (with more than 3 months of follow-up) of adults with symptomatic heart failure (HF) and left ventricular ejection fraction of 40% or more. Two individuals independently assessed studies for inclusion criteria and risk of bias using standard evaluation tools; discrepancies were resolved by consensus discussion. A total of 19 randomized trials (N = 20,663) met eligibility criteria and almost all had minimal, if any, significant risk of bias. Most of the study participants met criteria for symptomatic New York Heart Class II and III. No drug class was significantly associated with a reduced risk of all-cause or cardiovascular mortality. SGLT2 inhibitors, angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid receptor antagonists (MRAs) were significantly associated with a reduced risk of hospital admission compared with placebo, with a ranking analysis showing SGLT2 inhibitors as most likely to be the optimal treatment. The independent benefit of beta-blockers and angiotensin system inhibitors (eg, angiotensin-converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs]) in reducing HF-related hospital admissions was not significantly different than placebo.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Insuffisance cardiaque
L’article remet un peu en question les 4 piliers que nos collègues cardiologues nous présentent depuis quelques temps. La place des bêta bloqueurs n’a peut-être plus sa place. Et seul les ARNi, les inhibiteurs du SGLT-2 et les b’oqueurs des récepteurs des minerocorticoides ont leur place
heart Failure
Good to know hospital admissions for CHF san be reduced with these drugs
Very useful to know
Good to know it is not limited to Diabetic patients
Insuffisance cardiaque
Intéressant de voir qu'aucune classe de médicaments ne réduit la mortalité cardiaque ou la mortalité toute cause, et qu'en plus, les IECA, les ARA et les B-bloqueurs ne réduisent pas non plus les hospitalisations...