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Do alpha-adrenergic blockers really increase the risk of poor cardiovascular outcomes? An across-the-board meta-analysis
Session:
CO 10 - Insuficiência cardíaca crónica
Speaker:
José Pedro Sousa
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
José Pedro Sousa; Diogo Martins Rodrigues Mendonça; Rogerio Teixeira; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Due to presumed neurohormonal activation and fluid retention, alpha-adrenergic blockers (ABs) are avoided in the setting of heart disease, namely heart failure (HF) with reduced ejection fraction (HFrEF). However, this contraindication is mainly supported by ancient studies, having recently been challenged by newer ones.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Purpose: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To perform a comprehensive meta-analysis aimed at ascertaining the extent to which ABs influence cardiovascular (CV) outcomes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We systematically searched MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science for both prospective and retrospective studies, published until November 29th 2020, addressing the impact of ABs on acute heart failure (AHF), acute coronary syndrome (ACS), CV and all-cause mortality rate, as well as on left ventricular ejection fraction (LVEF) and exercise tolerance, by means of exercise duration. Both randomized controlled trials (RCTs) and studies specifically addressing HF patients were further investigated separately. Odds ratios (ORs) and mean differences (MDs) were pooled using traditional meta-analytic techniques, under a random-effects model.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">15 RCTs, 4 non-randomized prospective and 2 retrospective studies, encompassing 32.851, 19.374 and 71.600 patients, respectively, were deemed eligible. 14 studies, including 72.558 patients, comprised only chronic HF patients. 62.299 were allocated to AB. There were 25.998 AHF events, 1.325 ACSs, 954 CV and 33.566 all-cause deaths. ABs were, indeed, found to increase AHF risk (OR 1.78, 95% CI 1.46-2.16, i<sup>2</sup> 2%), although displaying no significant effect on ACS, CV and all-cause mortality rates (OR 1.02, 95% CI 0.91-1.15, i<sup>2</sup> 0%; OR 0.95, 95% CI 0.47-1.91, i<sup>2</sup> 17%; OR 1.1, 95% CI 0.84-1.43, i<sup>2</sup> 17%, respectively). When only HF patients were evaluated, ABs revealed themselves neutral towards AHF, ACS, CV and all-cause mortality events (OR 1.13, 95% CI 0.66-1.192, i<sup>2</sup> 0%; OR 0.49, 95% CI 0.1-2.47, i<sup>2</sup> 0%; OR 0.7, 95% CI 0.21-2.31, i<sup>2</sup> 21%; OR 1.09, 95% CI 0.53-2.23, i<sup>2</sup> 17%, respectively). As for HFrEF patients, ABs exerted a similarly inconsequential effect on AHF odds (OR 1.01, 95% CI 0.5-2.05, i<sup>2</sup> 6%). LVEF was not significantly influenced by ABs and exercise tolerance was even higher in those under this drug class (MD 139.16, 95% CI 65.52-212.8, i<sup>2</sup> 26%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ABs do seem to increase AHF odds, even though at the cost of those at lower risk, thus contradicting current guidelines. Other major CV outcomes appear unchanged.</span></span></p>
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