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Baseline Functional Class and Therapeutic Efficacy of Common Heart Failure Interventions: A Systematic Review and Meta-analysis.
- Source :
-
The Canadian journal of cardiology [Can J Cardiol] 2015 Jun; Vol. 31 (6), pp. 792-9. Date of Electronic Publication: 2015 Jan 07. - Publication Year :
- 2015
-
Abstract
- Background: New York Heart Association (NYHA) functional class provides important prognostic information and is often used to select patients for cardiovascular therapies, yet, the effect of NYHA class on therapeutic efficacy has not been systematically studied.<br />Methods: In this systematic review and meta-analysis we compared the relative and absolute mortality benefit of 5 common heart failure interventions (angiotensin-converting enzyme [ACE] inhibitors, β-blockers, mineralocorticoid receptor antagonists [MRAs], implantable cardioverter defibrillator [ICD], and cardiac resynchronization therapy [CRT]) across NYHA class. We included 26 randomized clinical trials of these interventions that reported all-cause mortality stratified according to baseline NYHA class in 36,406 patients.<br />Results: Pooled relative risk for NYHA I/II vs. III/IV strata were similar for ACE inhibitors (0.90 vs. 0.88), β-blockers (0.72 vs. 0.79), MRA (0.79 vs. 0.75), and CRT (0.80 vs. 0.80), with all heterogeneity P > 0.8. Conversely, ICD efficacy was greater for class I/II (relative risk, 0.65 vs 0.86, heterogeneity P = 0.02). The pooled absolute risk difference was smaller for NYHA I/II vs III/IV with ACE inhibitors (-0.02 vs. -0.06, P = 0.12), β-blockers (-0.02 vs. -0.05, P = 0.047), MRA (-0.03 vs. -0.11, P = 0.001), and CRT (-0.01 vs. -0.04, P = 0.036), but was similar across NYHA class for the ICD (-0.07 vs. -0.05; P = 0.27).<br />Conclusions: Relative mortality reductions with most interventions were independent of baseline NYHA class. However, ICD efficacy was greater with NYHA I/II vs. III/IV limitation, and absolute benefit was greater with higher NYHA class. For interventions other than the ICD, there is little evidence supporting use of NYHA class as a rigid criterion for selecting heart failure therapies.<br /> (Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adrenergic beta-Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Cardiac Pacing, Artificial methods
Cardiac Pacing, Artificial mortality
Cardiac Resynchronization Therapy mortality
Defibrillators, Implantable
Drug Therapy, Combination
Female
Heart Failure diagnosis
Humans
Male
Mineralocorticoid Receptor Antagonists therapeutic use
Prognosis
Randomized Controlled Trials as Topic
Risk Assessment
Survival Analysis
Treatment Outcome
Cardiac Resynchronization Therapy methods
Cause of Death
Heart Failure mortality
Heart Failure therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1916-7075
- Volume :
- 31
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Canadian journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 26022990
- Full Text :
- https://doi.org/10.1016/j.cjca.2014.12.031