The Efficacy of Various Pharmacological Agents on Long-Term Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis of Randomized Control Trials

The beneficial impacts of various drugs on long-term outcomes in patients with heart failure with preserved ejection fraction (HFpEF) have been a matter of controversy. The aim of this meta-analysis was to systematically review randomized control trials (RCTs) involving patients with heart failure with preserved left ventricular ejection fraction (LVEF) and identify the effects of various treatment options [angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin receptor blockers, and aldosterone receptor blockers] on all-cause mortality, cardiovascular mortality, and hospitalization due to cardiovascular reasons. The current meta-analysis has been conducted as per the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed without any restrictions on language by using the electronic databases Cochrane Library, EMBASE, and PubMed up to July 20, 2022. The outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, and hospitalization due to cardiovascular reasons. Overall, 10 articles were included in the current meta-analysis with a pooled sample size of 13,336 patients with HFpEF. In comparison to the placebo, among all four pharmacological agents, beta-blockers were the only agent that decreased the risk of all-cause mortality and cardiovascular outcomes. On the other hand, a significant reduction in hospitalization due to cardiac-related reasons was reported in patients on ACE inhibitors as compared to placebo. No other pharmacological agent had an impact on hospitalization due to cardiac-related reasons. The current meta-analysis indicates the possible benefits of beta-blockers in HFpEF in terms of reducing cardiovascular death and all-cause mortality.