Long-term survival in the Munich Mild Heart Failure Trial (MHFT)

Kleber, Franz X.; Niemöller, Lisa

doi:10.1016/0002-9149(93)90657-x

Cited by 8 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Table I summarizes, for each cardiac disease, the best‐available evidence for therapy existing in 1994 that we used in our study, according to the reference trials already mentioned (and available on request to the corresponding author). An example of the application of the above definitions to the field of chronic heart failure is as follows: for angiotensin‐converting enzyme (ACE) inhibitors, indicated best‐available evidence exists and includes the Consensus I study, 52 the SOLVD treatment trial, 53 the SOLVD prevention trial, 54 and the Munich Mild Heart Failure trial 55 , 56 . Combination therapy with hydralazine and isosorbide dinitrate can be recommended on the basis of the V‐HeFT1 trial, 57 which was classified as indicated best‐available evidence.…”

Section: Methodsmentioning

confidence: 99%

Implication of evidence-based medicine in prescription guidelines taught to French medical students: Current status in the cardiovascular field

Nony¹,

Cucherat²,

Boissel³

1999

Clinical Pharmacology & Therapeutics

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Implication of evidence-based medicine in prescription guidelines taught to French medical students: Current status in the cardiovascular field

Nony¹,

Cucherat²,

Boissel³

1999

Clinical Pharmacology & Therapeutics

View full text Add to dashboard Cite

show abstract

“…Follow-up lasted from 2.0 [20] to 44.0 [21,22] months, with the mean being 13.0 months. Total patients/exposure was 150,364 patients/year; 22 RCTs had at least 1000 patients/year.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Network meta‐analysis of medical therapy efficacy in more than 90,000 patients with heart failure and reduced ejection fraction

et al. 2022

View full text Add to dashboard Cite

Background Following the availability of new drugs for chronic heart failure (HF) with reduced ejection fraction (HFrEF), we sought to provide an updated and comparative synthesis of the evidence on HFrEF pharmacotherapy efficacy. Methods We performed a Bayesian network meta‐analysis of phase 2 and 3 randomized controlled trials (RCTs) of medical therapy in HFrEF patient cohorts with more than 90% of the participants with left ventricular ejection fraction less than 45% and all‐cause mortality reported. Results Sixty‐nine RCTs, accounting for 91,741 subjects, were evaluated. The step‐wise introduction of new drugs progressively decreased the risk of all‐cause death, up to reaching a random‐effects hazard ratio (HR) of 0.43 (95% credible intervals [CrI] 0.27–0.63) with beta blockers (BB), angiotensin‐converting enzyme inhibitors (ACEi), and mineralocorticoid receptor antagonist (MRA) versus placebo. The risk was further reduced by adding sodium–glucose cotransporter‐2 inhibitors (SGLT2i; HR 0.38, 95% CrI 0.22–0.60), ivabradine (HR 0.39, 95% CrI 0.21–0.64), or vericiguat (HR 0.40, 95% CrI 0.22–0.65) to neurohormonal inhibitors, and by angiotensin receptor–neprilysin inhibitor (ARNI), BB, and MRA (HR 0.36, 95% CrI 0.20–0.60). In a sensitivity analysis considering the ARNI and non‐ARNI subgroups of SGLT2i RCTs, the combination SGLT2i + ARNI + BB + MRA was associated with the lowest HR (0.28, 95% CrI 0.16–0.45 vs. 0.40, 95% CrI 0.24–0.60 for SGLT2i + BB + ACEi + MRA). Consistent results were obtained in sensitivity analyses and by calculating surface under the cumulative ranking area, as well as for cardiovascular mortality (information available for 56 RCTs), HF hospitalization (45 RCTs), and all‐cause hospitalization (26 RCTs). Conclusions Combination medical therapy including neurohormonal inhibitors and newer drugs, especially ARNI and SGLT2i, confers the maximum benefit with regard to HFrEF prognosis.

show abstract

“…There has been consistent RCT and meta-analysis evidence over the past 30 years demonstrating the benefits of ACEi’s in HFrEF, and subsequently ACEi’s have formed the cornerstone of HFrEF management [ 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. The benefits demonstrated have included improved LVEF [ 51 ], reduced mortality [ 52 , 53 , 54 , 56 , 58 , 59 ] and reduced hospitalization [ 53 , 54 ].…”

Section: Renin-angiotensin Aldosterone System (Raas) Inhibitionmentioning

confidence: 99%

“…However, the cited studies all excluded patients with severe CKD, and had a median baseline creatinine exclusion cut-off of 221 µmol/L (Interquartile range [IQR] 21) (Table 4 , Ref. [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]). Subgroup analyses of CKD patients included in these trials show no outcome modification by renal function at baseline, however, still included very few, if any patients with severe CKD [ 65 , 66 ].…”

Section: Renin-angiotensin Aldosterone System (Raas) Inhibitionmentioning

confidence: 99%

An Updated Review of the Management of Chronic Heart Failure in Patients with Chronic Kidney Disease

Tumelty,

Chung,

Hussain

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Chronic kidney disease (CKD) is common in patients with heart failure (HF) and is associated with high morbidity and mortality. There has been remarkable progress in the treatment of HF over recent years with the establishment of guideline-directed medical therapies including: (1) Beta-blockers, (2) renal angiotensin aldosterone system (RAAS) inhibition (i.e., angiotensin-converting enzyme inhibitor [ACEi], aldosterone receptor blocker [ARB] or angiotensin receptor-neprilysin inhibitor [ARNI]); (3) mineralocorticoid receptor antagonists (MRA), and (4) sodium-glucose cotransporter-2 inhibitors (SGLT2i). However, there are challenges to the implementation of these medications in patients with concomitant CKD due to increased vulnerability to common side-effects (including worsening renal function, hyperkalaemia, hypotension), and most of the pivotal trials which provide evidence of the efficacy of these medications excluded patients with severe CKD. Patients with CKD and HF often have regular healthcare encounters with multiple professionals and can receive conflicting guidance regarding their medication. Thus, despite being at higher risk of adverse cardiovascular events, patients who have both HF and CKD are more likely to be under-optimised on evidence-based therapies. This review is an updated summary of the evidence available for the management of HF (including reduced, mildly reduced and preserved left ventricular ejection fraction) in patients with various stages of CKD. The review covers the evidence for recommended medications, devices such as implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), intravenous (IV) iron, and discusses how frailty affects the management of these patients. It also considers emerging evidence for the prevention of HF in the cohort of patients with CKD. It synthesises the available evidence regarding when to temporarily stop, continue or rechallenge medications in this cohort. Chronic HF in context of CKD remains a challenging scenario for clinicians to manage, which is usually complicated by frailty, multimorbidity and polypharmacy. Treatment should be tailored to a patients individual needs and management in specialised cardio-renal clinics with a multi-disciplinary team approach has been recommended. This review offers a concise summary on this expansive topic.

show abstract

Long-term survival in the Munich Mild Heart Failure Trial (MHFT)

Cited by 8 publications

References 9 publications

Implication of evidence-based medicine in prescription guidelines taught to French medical students: Current status in the cardiovascular field

Implication of evidence-based medicine in prescription guidelines taught to French medical students: Current status in the cardiovascular field

Network meta‐analysis of medical therapy efficacy in more than 90,000 patients with heart failure and reduced ejection fraction

An Updated Review of the Management of Chronic Heart Failure in Patients with Chronic Kidney Disease

Contact Info

Product

Resources

About