Table 1.
Evidence supporting or refuting the benefits of treatments for heart failure with a left ventricular ejection fraction in the “mid-range” (HFmrEF: 40–49%)
| LVEF | Symptoms | Hospitalization for heart failurea | CV death or HFHa | CV mortality | All-cause mortality | |
|---|---|---|---|---|---|---|
| Diuretics | ||||||
| Perindopril | Improved | 0.38 (0.19–0.75) b | ||||
| Candesartan | Improved | 0.72 (0.55–0.95)∏ | 0.76 (0.61–0.96) | 0.81 (0.60–1.11) | 0.79 (0.60–1.04) | |
| Irbesartan | 0.98 (0.85–1.12)Δ | |||||
| ARNI (Sac/Val) vs. Valc | Improved | 0.77 (0.58–1.02) | 0.81 (0.64–1.03) | 0.94 (0.69–1.28) | NYR | |
| MRA (overall)c | 0.76 (0.46–1.27) | 0.72 (0.50–1.05) | 0.69 (0.43–1.12) | 0.73 (0.49–1.10) | ||
| MRA (Americas)c | 0.60 (0.32–1.10) | 0.55 (0.33–0.91) | 0.46 (0.23–0.94) | 0.58 (0.34–0.99) | ||
| ß-Blocker (SR) | Improved | 0.95 (0.68–1.32) | 0.83 (0.60–1.13) | 0.48 (0.24–0.97) | 0.59 (0.34–1.03) | |
| ß-Blocker (AF) | Improved | 1.15 (0.57–2.32) | 1.06 (0.58–1.94) | 0.86 (0.36–2.03) | 1.30 (0.63–2.67) | |
| Ivabradine | ||||||
| Digoxin | 0.80 (0.63–1.03) | 0.96 (0.79–1.17) | 1.24 (0.94–1.64) | 1.08 (0.85–1.37) | ||
| Rivaroxaban vs. aspirin | 0.65 (0.40–1.05) | 0.75 (0.53–1.06) | ||||
| Rivaroxaban+Aspirin vs. aspirin | 0.87 (0.56–1.35) | 0.63 (0.44–0.90) | ||||
| CRT | ||||||
| ICD | ||||||
| BNP-guided therapy | Reduction from 67% to 44% patients with an event |
Statistically significant results are shown in bold on a blue background. Blank cells indicate no relevant information reported. Other data shown are not significant, although may not be heterogeneous with the effect in patients with a reduced left ventricular ejection fraction (HFrEF). Data for sacubitril/valsartan taken from reference for LVEF >42.5% to 52.5%.98
AF, atrial fibrillation; ARNI, angiotensin receptor-neprilysin inhibitors; BNP, brain natriuretic peptide; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; LVEF, left ventricular ejection fraction; MRA, Mineralocorticoid receptor antagonist; SR, sinus rhythm.
Recurrent event analyses used when available.
The PEP-CHF trial specified inclusion of patients with LVEF 40–49% as was LVEF >49% but did not report effects in this subgroup. However, it did report effects in patients with a prior myocardial infarction who were more likely to have HFmrEF.
Stronger effect in women.