Pharmacological Heart Failure Treatment and its association with Outcomes of Postponement of Death

Introduction

• Heart failure (HF) is a serious condition and prevalent in 1-2% adults, with high mortality rates (~ 50%) within 5 years of HF diagnosis.
• Patient perception of measurements such as absolute risk reduction (RRR and ARR respectively) and number needed to treat (NNT) are inconsistent, which limits their value in conveying treatment effects.
• Patients are more responsive to outcome postponement (ie, higher values of outcome postponement are more likely to entail a greater treatment acceptance).
• The study aimed to estimate postponement of death for heart failure medications.

Methods

• The study included randomized placebo-controlled heart failure trials (≥ 1 year duration), with at least 1000 patients, and with patients with a left ventricular ejection fraction ≤40%.
• To ensure comparability between treatments all results were standardized to a 3-year trial duration.

Results

• 14 eligible trials, with a total of 52,014 patients were identified.
• Heart failure medications postponed death between 4 and 44 days. For drugs with a class I recommendation, death was postponed between 26 and 44 days.
• Postponement of all-cause mortality was greatest with beta-blockers 43.9 days (95% CI), 20.8 – 66.9) followed by aldosterone-antagonists 41.2 days (95% CI, 14.2 –68.2) and ACE-inhibitors (ACE-i) 41.0 days (95% CI, 18.8 – 63.3) (Figure).

Conclusion

• The modeled outcome postponement estimates reiterate beta-blockers, ACE-i and aldosterone antagonists as the mainstay of heart failure treatment.
• Ivabradine or ARBs added to ACE-i results in no statistically significant gain in survival.

Adapted from: Hansen MR, et al. Postponement of Death by Pharmacological Heart Failure Treatment: A Meta-Analysis of Randomized Clinical Trials. The American
Journal of Medicine. 2020 Jun;133(6):e280-e289.

Code: IN-NONC-00065