Systematic Evaluation And Meta Analysis Of SGC Stimulants In Patients With Heart Failure

ObjectiveHeart failure(HF)is a progressive,multifactor and heterogeneous syndrome.Although the signs and symptoms of heart failure have been improved rapidly and substantially in the hospital after standard treatment,about 25% of patients are hospitalized again within 30 days,and 30% of patients may die within one year.With the aging of the population and the increasing burden of heart failure,we have a huge medical demand for new and effective treatment strategies.In addition to short-term relief of HFrEF and HFpEF symptoms,new drugs should also provide long-term and long-term benefits in reducing incidence rate and mortality and improving health-related quality of life(HRQoL).Oral SGC stimulant is considered as a new strategy to treat heart failure,which can improve the quality of life of patients.Therefore,we conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the impact of this new SGC stimulant on the incidence of cardiovascular death or hospitalization,quality of life,NT proBNP,mortality and adverse events in patients withheart failure,so as to evaluate its effectiveness and safety.MethodsRandomized controlled trials(Studies published as of March 29,2020,without language restrictions)were systematically searched in EMBASE,PubMed,Cochrane,and MEDLINE to compare oral SGC stimulants with placebo.Main outcome measures: efficacy measures included cardiovascular death or hospitalization rate,EQ-5D index and NT proBNP change.Safety measures included all-cause mortality,serious adverse events,symptomatic hypotension and syncope.Fixed effect or random effect models were used to estimate odds ratio(or)or standardized mean difference(SMD),and their sensitivity and publication bias were analyzed.ResultsA total of 6 qualification tests(6255 participants)were included.Compared with placebo,SGC stimulants improved EQ-5D scores(SMD =0.44,95% CI = 0.24 to 0.63),reduced cardiovascular death or hospitalization(or = 0.88,95% CI = 0.79 to 0.98),and reduced the risk of serious adverse events(or = 0.90,95% CI = 0.81 to 1.00).There was no significant difference in NT proBNP between the two groups(SMD =-0.79,95% CI =-1.10 to-0.49).There was no significant difference in all-cause mortality between SGC stimulants and placebo(or = 0.95,95% CI = 0.83 to 1.09).Compared with the control group,SGC had no significant effect on the risk of symptomatic hypotension(or = 1.15,95% CI = 0.95 to 1.40)and syncope(or = 1.15,95% CI = 0.87 to 1.53).ConclusionThe new oral SGC stimulant can improve the incidence of hospitalization,reduce the risk of cardiovascular death and serious adverse events in patients with heart failure,while the risk of symptomatic hypotension and syncope in patients with heart failure is low,so it can be used in the clinical treatment of patients with heart failure.However,it still needs to be further used in clinical practice to determine the best treatment plan for the application of such drugs.