Heart failure


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Substantive changes at this update

Multidisciplinary interventions New evidence added.[20][21][23] Categorisation unchanged (Beneficial).

Exercise New evidence added.[25] Categorisation unchanged (Likely to be beneficial).

Angiotensin II receptor blockers for treating heart failure New evidence added.[33] Categorisation unchanged (Beneficial).

Beta-blockers New evidence added.[39] Categorisation unchanged (Beneficial).

Implantable cardiac defibrillators New evidence added.[83][85] Categorisation unchanged (Beneficial).

Cardiac resynchronisation therapy New evidence added.[89][85] Categorisation unchanged (Likely to be beneficial).

Coronary revascularisation New option added.[91] Categorised as Unknown effectiveness because evidence is insufficient to judge this intervention in heart failure.

ACE inhibitors in people at high risk of heart failure New evidence added.[98][103][104] Categorisation unchanged (Beneficial).

Angiotensin II receptor blockers in people at high risk of heart failure New option added.[105][106][103][104] Categorised as Likely to be beneficial.

ACE inhibitors or angiotensin II receptor blockers for diastolic heart failure New evidence added.[107] Categorisation changed from Unknown effectiveness to Unlikely to be beneficial.


INTRODUCTION: Heart failure occurs in 3% to 4% of adults aged over 65 years, usually as a consequence of coronary artery disease or hypertension, and causes breathlessness, effort intolerance, fluid retention, and increased mortality. The 5-year mortality in people with systolic heart failure ranges from 25% to 75%, often owing to sudden death following ventricular arrhythmia. Risks of cardiovascular events are increased in people with left ventricular systolic dysfunction (LVSD) or heart failure. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of multidisciplinary interventions for heart failure? What are the effects of exercise in people with heart failure? What are the effects of drug treatments for heart failure? What are the effects of devices for treatment of heart failure? What are the effects of coronary revascularisation for treatment of heart failure? What are the effects of drug treatments in people at high risk of heart failure? What are the effects of treatments for diastolic heart failure? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: aldosterone receptor antagonists, amiodarone, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, anticoagulation, antiplatelet agents, beta-blockers, calcium channel blockers, cardiac resynchronisation therapy, coronary revascularisation, digoxin (in people already receiving diuretics and angiotensin-converting enzyme inhibitors), exercise, hydralazine plus isosorbide dinitrate, implantable cardiac defibrillators, multidisciplinary interventions, non-amiodarone antiarrhythmic drugs, and positive inotropes (other than digoxin).

Cite as

McKelvie RS. Heart failure. Systematic review 204. BMJ Clinical Evidence. . 2011 August. Accessed [date].

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