Differences in ejection fraction as inclusion criterion in randomized controlled trials among patients with heart failure with reduced ejection fraction: a systematic review
Document Type
Journal Article
Publication Date
6-2-2022
Journal
Expert review of cardiovascular therapy
DOI
10.1080/14779072.2022.2085687
Keywords
Differences in ejection fraction; HFrEF; Randomized clinical trials; Systematic review
Abstract
INTRODUCTION: Heart failure (HF) with reduced ejection fraction (HFrEF) has been defined by varying ejection fraction (EF) criteria in clinical trials, leading to differences in quantifying treatment effects. AREAS COVERED: The definitions of HFrEF in randomized controlled trials from 2010 until 2020 were collected. The EF ranges were clustered into very low (<30%), low (30-39%) and mildly reduced (40-49%) stratified by intervention. Time series regression analysis was performed.A total of 3052 articles were screened and 706 were included. Interventions included were pharmacologic (37%), device therapy (10%) and 53% a combination of programs, procedural, and laboratory testing. By EF cutoffs, 41% of the studies utilized <40% while 26% used <35%. About 31% did not have a clearly defined EF. Between 2010-2020, studies with HFrEF ranges 30-39% have significantly decreased (p value<0.001 for trend) but those which included very low EF (<30%) and mildly reduced EF (40-49%) have remained the same. EF definitions across clinical trials in HFrEF varied widely. Defining the specific target HF population phenotype when designing trials or in patient treatment is important as various beneficial effects of different heart failure treatment modalities can be modified or even attenuated across the spectrum of EF.
APA Citation
Al Sudani, Hussein; Lo, Kevin Bryan; Essa, Hani; Wattoo, Ammaar; Gulab, Asma; Akhtar, Hamza; Angelim, Lucas; Helfman, Beth; Peterson, Eric; Brousas, Sophia; Whybrow-Huppatz, Isabel; Yazdanyar, Ali; Soman, Sandeep; Sankaranarayanan, Rajiv; and Rangaswami, Janani, "Differences in ejection fraction as inclusion criterion in randomized controlled trials among patients with heart failure with reduced ejection fraction: a systematic review" (2022). GW Authored Works. Paper 1161.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1161
Department
Medicine