Cochrane · systematic review · CD012721
Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved ejection fraction
Martin, N, Manoharan, K, Davies, C, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
25
current version
GRADE rated
25
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 4 · 16%Low 4 · 16%Moderate 9 · 36%High 8 · 32%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyBeta‐blockers compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: patients with chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) Beta‐blockers vs placebo or no treatment | RR 0.78 [0.62, 0.99] | 3 studies · 1046 participants | Low Downgraded: risk of bias |
Heart failure hospitalisation (RR) Beta‐blockers vs placebo or no treatment | RR 0.73 [0.47, 1.13] | 4 studies · 449 participants | Very low Downgraded: risk of bias |
Hyperkalaemia Beta‐blockers vs placebo or no treatment | no estimate extracted | 1 study · 245 participants | Very low Downgraded: risk of bias |
All‐cause mortality (RR) Beta‐blockers vs placebo or no treatment | RR 0.82 [0.67, 1] | 4 studies · 1105 participants | Low Downgraded: risk of bias |
Quality of life (MLHFQ): from 0 to 105 Beta‐blockers vs placebo or no treatment | no estimate extracted | 1 study · 93 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Mineralocorticoid receptor antagonists (MRAs) compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: patients with chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) Mineralocorticoid receptor antagonists (MRAs) vs placebo or no treatment | RR 0.9 [0.74, 1.11] | 3 studies · 4070 participants | Moderate Downgraded: imprecision |
Heart failure hospitalisation (RR) Mineralocorticoid receptor antagonists (MRAs) vs placebo or no treatment | RR 0.82 [0.69, 0.98] | 3 studies · 3714 participants | Moderate Downgraded: imprecision |
Hyperkalaemia Mineralocorticoid receptor antagonists (MRAs) vs placebo or no treatment | RR 2.11 [1.77, 2.52] | 6 studies · 4291 participants | High |
All‐cause mortality Mineralocorticoid receptor antagonists (MRAs) vs placebo or no treatment | RR 0.91 [0.78, 1.06] | 5 studies · 4207 participants | Moderate Downgraded: imprecision |
Quality of life (MLHFQ): from 0 to 105 Mineralocorticoid receptor antagonists (MRAs) vs placebo or no treatment | no estimate extracted | 3 studies · 511 participants | Low Downgraded: risk of bias, imprecision |
Angiotensin‐converting enzyme inhibitors (ACEIs) compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: patients with chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) Angiotensin‐converting enzyme inhibitors (ACEIs) vs placebo or no treatment | RR 0.93 [0.61, 1.42] | 2 studies · 945 participants | Moderate Downgraded: imprecision |
Heart failure hospitalisation (RR) Angiotensin‐converting enzyme inhibitors (ACEIs) vs placebo or no treatment | RR 0.86 [0.64, 1.15] | 3 studies · 1019 participants | Moderate Downgraded: imprecision |
Hyperkalaemia Angiotensin‐converting enzyme inhibitors (ACEIs) vs placebo or no treatment | no estimate extracted | 1 study · 74 participants | Very low Downgraded: imprecision |
All‐cause mortality (RR) Angiotensin‐converting enzyme inhibitors (ACEIs) vs placebo or no treatment | RR 1.04 [0.75, 1.45] | 5 studies · 1187 participants | Moderate Downgraded: imprecision |
Quality of life (MLHFQ): from 0 to 105 Angiotensin‐converting enzyme inhibitors (ACEIs) vs placebo or no treatment | no estimate extracted | 2 studies · 154 participants | Low Downgraded: risk of bias, imprecision |
Angiotensin receptor blockers (ARBs) compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: patients with chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) Angiotensin receptor blockers (ARBs) vs placebo or no treatment | RR 1.02 [0.9, 1.14] | 3 studies · 7254 participants | High |
Heart failure hospitalisation (RR) Angiotensin receptor blockers (ARBs) vs placebo or no treatment | RR 0.92 [0.83, 1.02] | 3 studies · 7254 participants | High |
Hyperkalaemia Angiotensin receptor blockers (ARBs) vs placebo or no treatment | RR 1.88 [1.07, 3.33] | 2 studies · 7148 participants | High |
All‐cause mortality (RR) Angiotensin receptor blockers (ARBs) vs placebo or no treatment | RR 1.01 [0.92, 1.11] | 4 studies · 7964 participants | High |
Quality of life (MLHFQ): from 0 to 105 Angiotensin receptor blockers (ARBs) vs placebo or no treatment | no estimate extracted | 3 studies · 3117 participants | High |
Angiotensin receptor neprilysin inhibitors (ARNIs) compared to usual care for chronic heart failure with preserved ejection fraction
Population: patients with chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) Median Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care | RR 0.96 [0.79, 1.15] | 1 study · 4796 participants | Moderate Downgraded: imprecision |
Heart failure hospitalisation, first (RR) Range of Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care | RR 0.89 [0.8, 1] | 2 studies · 7362 participants | Moderate Downgraded: imprecision |
Hyperkalaemia Range of Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care | RR 0.88 [0.77, 1.01] | 2 studies · 5054 participants | Moderate Downgraded: imprecision |
All‐cause mortality (RR) Range of Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care | RR 0.97 | 3 studies · 7663 participants | High |
Quality of life Range of Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care | no estimate extracted | 118 participants | High |
Beta‐blockers compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) Beta‐blockers vs placebo or no treatment | RR 0.78 [0.62, 0.99] | 3 studies · 1046 participants | Low Downgraded: risk of bias |
Heart failure hospitalisation (RR) Beta‐blockers vs placebo or no treatment | RR 0.73 [0.47, 1.13] | 4 studies · 449 participants | Very low Downgraded: risk of bias |
Hyperkalaemia Beta‐blockers vs placebo or no treatment | no estimate extracted | 1 study · 245 participants | Very low Downgraded: risk of bias |
All‐cause mortality (RR) Beta‐blockers vs placebo or no treatment | RR 0.82 [0.67, 1] | 4 studies · 1105 participants | Low Downgraded: risk of bias |
Quality of life (Minnesota) Scale from: 0 to 105 Beta‐blockers vs placebo or no treatment | no estimate extracted | 1 study · 93 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
MRA compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) MRA vs placebo or no treatment | RR 0.9 [0.74, 1.11] | 3 studies · 4070 participants | Moderate Downgraded: imprecision |
Heart failure hospitalisation (RR) MRA vs placebo or no treatment | RR 0.82 [0.69, 0.98] | 3 studies · 3714 participants | Moderate Downgraded: imprecision |
Hyperkalaemia MRA vs placebo or no treatment | RR 2.11 [1.77, 2.52] | 6 studies · 4291 participants | High |
All‐cause mortality MRA vs placebo or no treatment | RR 0.91 [0.78, 1.06] | 5 studies · 4207 participants | Moderate Downgraded: imprecision |
Quality of life (Minnesota) Scale from: 0 to 105 MRA vs placebo or no treatment | no estimate extracted | 3 studies · 511 participants | Low Downgraded: imprecision |
ACEI compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) ACEI vs placebo or no treatment | RR 0.93 [0.61, 1.42] | 2 studies · 945 participants | Moderate Downgraded: imprecision |
Heart failure hospitalisation (RR) ACEI vs placebo or no treatment | RR 0.86 [0.64, 1.15] | 3 studies · 1019 participants | Moderate Downgraded: imprecision |
Hyperkalaemia ACEI vs placebo or no treatment | no estimate extracted | 1 study · 74 participants | Very low Downgraded: imprecision |
All‐cause mortality (RR) ACEI vs placebo or no treatment | RR 0.99 [0.71, 1.38] | 4 studies · 1079 participants | Moderate Downgraded: imprecision |
Quality of life (Minnesota) Scale from: 0 to 105 ACEI vs placebo or no treatment | no estimate extracted | 2 studies · 154 participants | Low Downgraded: risk of bias, imprecision |
ARB compared to placebo or no treatment for chronic heart failure with preserved ejection fraction
Population: chronic heart failure with preserved ejection fraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality (RR) ARB vs placebo or no treatment | RR 1.02 [0.9, 1.14] | 3 studies · 7254 participants | High |
Heart failure hospitalisation (RR) ARB vs placebo or no treatment | RR 0.92 [0.83, 1.02] | 3 studies · 7254 participants | High |
Hyperkalaemia ARB vs placebo or no treatment | RR 1.88 [1.07, 3.33] | 2 studies · 7148 participants | High |
All‐cause mortality (RR) ARB vs placebo or no treatment | RR 1.01 [0.92, 1.11] | 4 studies · 7964 participants | High |
Quality of life (Minnesota) scale from: 0 to 105 ARB vs placebo or no treatment | no estimate extracted | 3 studies · 3117 participants | High |