Skip to content
Research Article Open access CC BY 3.0

Heart Failure with Preserved Ejection Fraction and Therapeutic Approaches: A Systematic Review and Meta-analysis

Nader Makki, Amy Blevins Mals

Cardiology and Angiology: An International Journal · pp. 332–346 · Published 25 Jul 2014

10.9734/CA/2014/11641

Abstract

Aims: Evidence is still lacking regarding optimal treatment for patients with heart failure with preserved ejection fraction (HfPEF). Our objective is to present an individual evaluation for each of the current available heart failure medications using a meta-analytical model. Methods and Results: Using meta-analytical techniques we assessed the impact of standard systolic heart failure medications on the combined endpoint of all-cause mortality and/or hospitalization for heart failure as a primary endpoint and on mortality and heart failure hospitalization as separate secondary endpoints for patients with HfPEF. Studies were heterogeneous (Q test, p=0.01) and a random effect model was adopted for analysis. A total of 22 randomized and prospective observational studies of 16,802 patients were included; mean follow up duration was 27 months. Only angiotensin converting enzyme inhibitors (ACEIs) significantly reduced the composite end point of all-cause mortality and /or hospitalization for heart failure (HR 0.74 & 95% CI [0.61-0.89], p=0.01). As for all-cause mortality, only ACEIs (HR 0.57 & 95% CI [0.45-0.71], p=0.005), beta blockers (HR 0.63 & 95% CI [0.41-0.98], p=0.03) and statins (HR 0.41 & 95% CI [0.23-0.72], p=0.001) offered a survival benefit. As for hospitalization for heart failure, only digoxin had a significant effect (HR 0.77 & 95% CI [0.61-0.98], p=0.02).                                                                                                                                                                         Conclusions: Our analysis suggests that ACEI, beta blockers, statin and digoxin as potential medications that can improve outcomes in patients with HfPEF. However, prospective randomized studies are needed to better assess response to these medications.  

Heart failure with preserved ejection fraction all-cause mortality heart failure related hospitalization

References (40)

  1. 1 Meta-analysis of Observational Studies in Epidemiology A Proposal for Reporting [DOI]
  2. 2 2013 ACCF/AHA Guideline for the Management of Heart Failure [DOI]
  3. 3 Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction [DOI]
  4. 4 Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction [DOI]
  5. 5 Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial [DOI]
  6. 6 Epidemiology and risk profile of heart failure [DOI]
  7. 7 Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study [DOI]
  8. 8 Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction [DOI]
  9. 9 Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS) [DOI]
  10. 10 The perindopril in elderly people with chronic heart failure (PEP-CHF) study [DOI]
  11. 11 Diastolic Stiffness of the Failing Diabetic Heart [DOI]
  12. 12 Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase] [DOI]
  13. 13 Effects of Digoxin on Morbidity and Mortality in Diastolic Heart Failure [DOI]
  14. 14 Heart Failure With a Normal Ejection Fraction [DOI]
  15. 15 Epidermal Growth Factor Receptor Tyrosine Kinase as a Target for Anticancer Therapy [DOI]
  16. 16 Statin Therapy May Be Associated With Lower Mortality in Patients With Diastolic Heart Failure [DOI]
  17. 17 Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure [DOI]
  18. 18 Effect of Propranolol Versus No Propranolol on Total Mortality Plus Nonfatal Myocardial Infarction in Older Patients with Prior Myocardial Infarction, Congestive Heart Failure, and Left Ventricular Ejection Fraction ≥40% Treated With Diuretics Plus Angiotensin-Converting Enzyme Inhibitors [DOI]
  19. 19 Driving Times and Distances to Hospitals With Percutaneous Coronary Intervention in the United States [DOI]
  20. 20 Effect of Carvedilol on Diastolic Function in Patients with Diastolic Heart Failure and Preserved Systolic Function. Results of the Swedish Doppler-Echocardiographic Study (SWEDIC) [DOI]
  21. 21 Elevated Cardiac Troponin Measurements in Critically Ill Patients [DOI]
  22. 22 The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction [DOI]
  23. 23 Effects of Treatment on Exercise Tolerance, Cardiac Function, and Mortality in Heart Failure With Preserved Ejection Fraction [DOI]
  24. 24 Erlotinib Effectively Inhibits JAK2V617F Activity and Polycythemia Vera Cell Growth [DOI]
  25. 25 Heart failure management using implantable devices for ventricular resynchronization: Comparison of medical therapy, pacing, and defibrillation in chronic heart failure (COMPANION) trial [DOI]
  26. 26 Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors [DOI]
  27. 27 Prescription of Beta-Blockers in Patients with Advanced Heart Failure and Preserved Left Ventricular Ejection Fraction. Clinical Implications and survival [DOI]
  28. 28 The Effect of Quinapril on Functional Status of Elderly Patients with Diastolic Heart Failure [DOI]
  29. 29 Efficacy of ACE inhibitors in chronic heart failure with preserved ejection fraction — A meta analysis of 7 prospective clinical studies [DOI]
  30. 30 Effect of Beta-Blocker Therapy on Rehospitalization Rates in Women Versus Men With Heart Failure and Preserved Ejection Fraction [DOI]
  31. 31 Use of angiotensin-converting enzyme inhibitors in heart failure with preserved left ventricular systolic function [DOI]
  32. 32 Long-term outcome after a first episode of heart failure. A prospective 7-year study [DOI]
  33. 33 Comparison of Outcomes and Usefulness of Carvedilol Across a Spectrum of Left Ventricular Ejection Fractions in Patients With Heart Failure in Clinical Practice [DOI]
  34. 34 Angiotensin-Converting Enzyme Inhibitors Prescription Is Associated With Longer Survival Among Patients Hospitalized for Congestive Heart Failure Who Have Preserved Systolic Function: A Long-Term Follow-Up Study [DOI]
  35. 35 Statin Therapy in Patients with Diastolic Heart Failure [DOI]
  36. 36 Digoxin and Reduction of Heart Failure Hospitalization in Chronic Systolic and Diastolic Heart Failure [DOI]
  37. 37 Relation of β-Blocker Use With Frequency of Hospitalization for Heart Failure in Patients With Left Ventricular Diastolic Dysfunction (from the Heart and Soul Study) [DOI]
  38. 38 Mortality and morbidity of newly diagnosed heart failure treated with statins [DOI]
  39. 39 Successful treatment of hypertension accounts for improvements in markers of diastolic function − a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies [DOI]
  40. 40 Heart failure with preserved ejection fraction: is this diastolic heart failure?**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. [DOI]

Cited by 2

Nursing Diagnoses in Heart Failure: Integrative Review

Daniele Melo Sardinha, Leila de Massena e Neiva Assis, Alexsandro Soares Amoedo, Katia Regina de Oliveira Gonçalves, Renato Hugo Dias Melo, Cassia Andreia Silva Lima, Jessica da Silva Ferreira, Jaqueline Cristina da Silva Belém, Jaqueline Dantas Neres Martin, Gabriel Fazzi Costa, Aurenice Monteiro Pinto Gualdez, Alziney Simor · Cardiology and Angiology: An International Journal · 2020

Showing 1 of 2 known citations — external sources report more than can currently be individually listed.

Article metrics

Real usage data collected on this platform.

70

Page views

0

PDF downloads

43

Outbound clicks

2

Citations

Views over time

Views by country

Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".

Traffic sources

Referring site, by host.

Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.