Efficacy Of ARNI,sGCs,SGLT2i,and Omecamtiv Mecarbil In The Treatment Of Heart Failure:A Network Meta-Analysis

Objective:This study aimed to systematic evaluation of Angiotensin Receptor Neprilysin Inhibitors,Soluble Guanylate Cyclase Stimulators)Sodium-Glucose Transporter 2Inhibitors(SGLT2i),Soluble Guanylate Cyclase Stimulators,s GCs)or omecamtiv mecarbil in the treatment of chronic heart failure(CHF).Methods:Computerized searches in CNKI,Wan Fang Data,VIP,Pubmed,Embase,The Cochrane Library databases collected randomized controlled trials of ARNI,SGLT2 i,s GCs,or omecamtiv mecarbil in patients with chronic heart failure(RCTs),and the retrieval period was from the establishment of the database to October 2022.Two reviewers independently screened literature,extracted data,and evaluated the bias risk of included studies.Review Manager5.3,Stata17.0 and other software were used for mesh meta-analysis.The primary end point was the rate of complex events of cardiovascular death and hospitalization for heart failure;Secondary endpoints were rehospitalization rate for heart failure,cardiovascular mortality,all-cause mortality,and Kansas City Cardiomyopathy Questionnaire(KCCQ).Results:A total of 21 studies were included,including 45,287 patients with chronic heart failure.The results of mesh meta-analysis:in terms of rates of cardiovascular death or heart failure rehospitalization,SGLT2i+C(RR=0.78,95%CI [0.73,0.84]),Sacubitril/Valsartan+C(RR=0.84,95%CI[0.80,0.89])and s GCs+C(RR=0.92,95%CI[0.85,0.99])were better than C(conventional drug therapy for heart failure);In terms of heart failure rehospitalization rate,SGLT2i+C(RR=0.73,95%CI[0.68,0.78]),Sacubitril/Valsartan+C(RR=0.82,95%CI[0.77,0.88])were superior to conventional drug therapy for heart failure,and SGLT2i+C(RR=0.88,95%CI[0.80,0.97])was better than Sacubitril/Valsartan+C;In terms of cardiovascular mortality,Sacubitril/Valsartan+C,SGLT2i+C,and s GCs+C were lower than conventional heart failure medications,Sacubitril/Valsartan+C(RR=0.82,95%CI[0.74,0.91]),SGLT2i+C(RR=0.86,95%CI[0.77,0.96]),s GCs+C(RR=0.94,95%CI[0.82,1.08]);In terms of all-cause mortality,Sacubitril/Valsartan+C(RR=0.86,95%CI [0.72,0.98])was superior to conventional drug therapy for heart failure.In terms of Kansas City cardiomyopathy questionnaire scores,Sacubitril/Valsartan+C and SGLT2i+C were superior to conventional heart failure medications;SGLT2i+C MD=6.44,95%CI[2.40,17.31],Sacubitril/Valsartan+C(MD=1.96,95%CI[0.83,4.42]);The SUCRA ranking results were as follows: cardiovascular death or heart failure rehospitalization were SGLT2i+C,Sacubitril/Valsartan+C,s GCs+C,omecamtiv Mecarbill +C,and conventional heart failure medication.In terms of all-cause mortality,the ranking was Sacubitril/Valsartan+C,SGLT2i+C,s GCs+C,conventional heart failure drug therapy;In terms of cardiovascular mortality,the ranking was Sacubitril/Valsartan+C,SGLT2i+C,conventional heart failure drug therapy,omecamtiv mecarbil++C and s GCs+C;Kansas City cardiomyopathy Questionnaire score,ranking SGLT2i+C,Sacubitril/Valsartan+C,conventional heart failure medication.Conclusion:To sum up,four heart failure drugs can improve the prognosis of heart failure,and the efficacy of s GCs and omecamtiv mecarbil regimens may not be as good as that of ARNI and SGLT2 i regimens.ARNI regimen may be the most effective in improving all-cause and cardiovascular mortality.SGLT2 i regimen may have the best effect in improving the compound event rate of cardiovascular death and heart failure rehospitalization,the rate of rehospitalization due to heart failure and improving KCCQ score.The increasing use of conventional and four heart failure drug combinations will help to further reduce the hospitalization and mortality rates of patients with heart failure.