Cochrane systematic review on heart failure treatments published by BMJ Heart.

Heart failure is an increasingly common cardiovascular condition that remains associated with poor health outcomes. For approximately half of all patients with heart failure patients, in whom left ventricular ejection fraction (LVEF) is >40%, no treatments are available that are proven to be effective at improving outcomes. Ejection fractions measure how much blood is pumped from the heart with each beat, the Cleveland Clinic website provides a good explanation.

A team of clinicians and evidence specialists led by IHI’s Tom Lumbers,

performed a Cochrane systematic review and meta-analysis to investigate the effects of renin-angiotensin-aldosterone system (RAAS) inhibition in heart failure patients with LVEF. RAAS plays a pivotal role in the pathogenesis of heart failure and inhibitors of this system are often used to treat the disease. However, to date, the effectivity of these inhibitors at improving survival and reducing hospitalisation rates has only been proven in heart failure patients with LVEF <40%.

The researchers identified 207 reports from 37 randomised controlled trials and combined the results, where possible, through meta-analysis. They concluded that, among inhibitors of components of the RAAS, mineralocorticoid receptor antagonists are probably beneficial, angiotensin receptor (a major component of the RAAS) blockers probably have little or no effect, and that there is insufficient evidence available for beta-blockers and other RAAS inhibitors to determine whether or not these are beneficial.

The authors reflect that there is a need and an opportunity for new to develop new treatment paradigms for this patient group informed by mechanistic insights from large-scale omic and EHR data resources.

To read the the Cochrane Corner synopsis visit the BMJ, Heart Website or follow this link for a free pdf version.

The paper’s full reference is: Lumbers RT, Martin N, Manoharan K, et al Do beta-blockers and inhibitors of the renin–angiotensin aldosterone system improve outcomes in patients with heart failure and left ventricular ejection fraction >40%? Heart Published Online First: 25 July 2019. doi: 10.1136/heartjnl-2018-313855. The full Cochrane review report is available from the Cochrane Database of Systematic Reviews (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012721.pub2/full