Patient-Centered Outcomes in Heart Failure Pharmacotherapy: A Meta-Analysis of Randomized Controlled Trials.

backgroundHeart failure (HF) guideline-directed medical therapy is shown to reduce mortality and morbidity in patients with HF. However, less is known about the impact of HF pharmacotherapy on quality of life (QOL) and exercise capacity.

objectivesThe primary objective of our meta-analysis is to quantify the benefits of HF pharmacotherapy on patient-centered outcomes (QOL with Kansas City Cardiomyopathy Questionnaire [KCCQ] score and exercise capacity with 6-minute walking distance [6MWD]) in chronic HF.

methodsRandomized controlled trials in the ambulatory HF setting were included. The intervention group included intravenous (IV) iron therapy, beta-blockers, sodium glucose co-transporter (SGLT) 2 inhibitors, angiotensin receptor neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRA), vericiguat, ivabradine, and glucagon-like peptide 1 (GLP1) or GLP1/glucose-dependent insulinotropic polypeptide (GIP) agonists. The coprimary outcomes were the KCCQ score for QOL and 6MWD for exercise capacity.

resultsThe uses of IV iron, SGLT2 inhibitors, and GLP1 or GLP1/GIP agonists significantly showed improvement in KCCQ score compared to the placebo group. No significant differences in KCCQ score were found between MRA, ARNI, vericiguat, or ivabradine, and placebo or active control groups. The use of GLP1 or GLP1/GIP agonists and IV iron significantly improved 6MWD compared to the placebo group. There were no significant differences in 6MWD between SGLT2 inhibitors, ARNI, beta-blocker, MRA, or ivabradine, and placebo or active control group.

conclusionsIV iron and GLP1 agonists or GLP1/GIP agonists improved both QOL and exercise capacity in patients with HF. SGLT2 inhibitors significantly improved QOL but had no significant effect on exercise capacity.