Outcome | All trials | Drug classes | Follow-up duration | Entry LV ejection fraction threshold | Mean LV ejection fraction | |||||
Beta-blockers | RAAS antagonists | Other | 3–12 months | >12 months | 40%–49% | ≥50% | <60% | ≥60% | ||
All-cause mortality | 0.96 (0.90 to 1.03) | 0.78 (0.65 to 0.94) p=0.008 | 1.00 (0.93 to 1.08) | 0.95 (0.78 to 1.15) | 0.79 (0.66 to 0.95) p=0.01 | 0.99 (0.92 to 1.06) | 0.96 (0.88 to 1.03) | 0.99 (0.74 to 1.32) | 0.93 (0.82 to 1.05) | 1.01 (0.90 to 1.12) |
Cardiovascular mortality | 0.95 (0.87 to 1.03) | 0.75 (0.60 to 0.94) p=0.01 | 0.99 (0.89 to 1.09) | 1.01 (0.76 to 1.34) | 0.71 (0.55 to 0.90) p=0.005 | 0.99 (0.90 to 1.08) | 0.95 (0.87 to 1.03) | - | 0.90 (0.78 to 1.05) | 1.02 (0.89 to 1.17) |
Heart failure hospitalisation | 0.88 (0.81 to 0.95) p=0.002 | 0.67 (0.42 to 1.07) | 0.90 (0.82 to 0.98) p=0.01 | 0.81 (0.64 to 1.04) | 0.67 (0.48 to 0.94) p=0.02 | 0.90 (0.82 to 0.98) p=0.02 | 0.88 (0.82 to 0.96) p=0.002 | 0.51 (0.18 to 1.48) | 0.85 (0.76 to 0.94) p=0.002 | 0.92 (0.82 to 1.04) |
Data presented as risk ratios (for all-cause and cardiovascular mortality and hospitalisation outcomes) or mean difference (exercise capacity, 6MWD, VO2 max and MLHFQ), with 95% CI and I2 statistic. p values included for analyses that reached statistical significance at p=0.05. RAAS blockers include all trials using ACE inhibitors, angiotensin receptor blockers and mineralocorticoid (each class individually had no effect on all-cause mortality, cardiovascular mortality or heart failure hospitalisation). Only one trial that reported cardiovascular mortality had an entry LV ejection fraction ≥50%. Only one trial with LV ejection fraction threshold ≥50% reported cardiovascular mortality.
6MWD, 6 min walk distance; LV, left ventricular; MLHFQ, Minnesota Living With Heart Failure Questionnaire; RAAS, renin-angiotensin-aldosterone system.