Pharmacologic Treatment of Heart Failure With Reduced Ejection Fraction

作者：Bart J. van Essen, Daan C H Ceelen, Wouter Ouwerkerk, Tiew‐Hwa Katherine Teng, Ganash N Tharshana, Fook Ming Hew, Javed Butler, Faı̈ez Zannad, Carolyn S.P. Lam, Justin A. Ezekowitz, Adriaan A. Voors, Jasper Tromp · 发表于：Journal of the American College of Cardiology · 年份：2025 · DOI：10.1016/j.jacc.2025.08.054 · 被引用次数：29 · 研究领域：Heart Failure Treatment and Management、Diabetes Treatment and Management、Cardiovascular Function and Risk Factors

BACKGROUND: In 2022, a network meta-analysis showed that a combination of β-blockers, angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2i) was most effective in reducing all-cause mortality in heart failure with reduced ejection fraction (HFrEF). This study updates the treatment benefit by including additional large randomized controlled trials (RCTs) since 2022, including the VICTOR (Vericiguat Global Study in Participants with Chronic Heart Failure) trial. OBJECTIVES: The goal of this study was to evaluate and compare regimens of pharmacotherapy in patients with HFrEF. METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for RCTs in patients with HFrEF through April 2025. Using frequentist network meta-analysis, HRs for all-cause mortality (primary outcome), cardiovascular death, and the composite of cardiovascular death or heart failure hospitalization (secondary outcomes) were estimated. Absolute benefits were quantified as life-years gained by using BIOSTAT-CHF (Biology Study to Tailored Treatment in Chronic Heart Failure) and ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) cohort data. RESULTS: The analysis included 103,754 patients across 89 randomized controlled trials. Relative to placebo, quintuple therapy with ARNi, β-blockers, MRAs, SGLT2i, and vericiguat most effectively reduced all-cause mortality (HR: 0.35; 9...