medwireNews: Comprehensive therapy with medications including a sodium-glucose cotransporter (SGLT)2 inhibitor should provide several additional years of event-free and overall survival for people who have heart failure with reduced ejection fraction (HFrEF), shows an analysis in The Lancet.
Scott Solomon (Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA) and colleagues looked at outcomes in the EMPHASIS-HF, PARADIGM-HF, and DAPA-HF trials, which respectively tested eplerenone versus placebo, sacubitril–valsartan against enalapril, and dapagliflozin versus placebo.
They calculated that comprehensive therapy with an angiotensin receptor–neprilysin inhibitor, beta blocker, mineralocorticoid receptor antagonist, and an SGLT2 inhibitor provided overall survival gains relative to limited conventional treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus a beta blocker. These ranged from 1.4 additional years for an 80-year-old to 6.3 years for a 55-year-old.
Comprehensive treatment also provided gains in survival free of heart failure hospitalization, ranging from 2.7 additional years for an 80-year-old to 8.3 years for a 55-year-old.
In a linked comment, Mitchell Psotka (Inova Heart and Vascular Institute, Falls Church, Virginia, USA) and John Teerlink (San Francisco Veterans Affairs Medical Center, California, USA) describe the analysis as “valuable.”
But they caution that “estimates of treatment effects for therapies beyond the time period studied in these clinical trials […] require multiple assumptions about the therapy, the treated populations, and the statistical analyses used.”
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Lancet 2020; doi:10.1016/S0140-6736(20)30748-0
Lancet 2020; doi:10.1016/S0140-6736(20)30929-6