scholarly journals Non‐insulin antihyperglycaemic drugs and heart failure: an overview of current evidence from randomized controlled trials

2020 ◽  
Vol 7 (6) ◽  
pp. 3438-3451
Author(s):  
Gianluigi Savarese ◽  
Benedikt Schrage ◽  
Francesco Cosentino ◽  
Lars H. Lund ◽  
Giuseppe M.C. Rosano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trials ◽  
Current Evidence ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Antihyperglycaemic Drugs

scholarly journals Dyspnea Measurement in Acute Heart Failure: A Systematic Review and Evidence Map of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyu Zhang ◽  
Chen Zhao ◽  
Houjun Zhang ◽  
Wenjing Liu ◽  
Jingjing Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Acute Heart Failure ◽  
Current Evidence ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Analytical Approaches

Background: Dyspnea is the most common presenting symptom among patients hospitalized for acute heart failure (AHF). Dyspnea relief constitutes a clinically relevant therapeutic target and endpoint for clinical trials and regulatory approval. However, there have been no widely accepted dyspnea measurement standards in AHF. By systematic review and mapping the current evidence of the applied scales, timing, and results of measurement, we hope to provide some new insights and recommendations for dyspnea measurement.Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched from inception until August 27, 2020. Randomized controlled trials (RCTs) with dyspnea severity measured as the endpoint in patients with AHF were included.Results: Out of a total of 63 studies, 28 had dyspnea as the primary endpoint. The Likert scale (34, 54%) and visual analog scale (VAS) (22, 35%) were most widely used for dyspnea assessment. Among the 43 studies with detailed results, dyspnea was assessed most frequently on days 1, 2, 3, and 6 h after randomization or drug administration. Compared with control groups, better dyspnea relief was observed in the experimental groups in 21 studies. Only four studies that assessed tolvaptan compared with control on the proportion of dyspnea improvement met the criteria for meta-analyses, which did not indicate beneficial effect of dyspnea improvement on day 1 (RR: 1.16; 95% CI: 0.99–1.37; p = 0.07; I2 = 61%).Conclusion: The applied scales, analytical approaches, and timing of measurement are in diversity, which has impeded the comprehensive evaluation of clinical efficacy of potential therapies managing dyspnea in patients with AHF. Developing a more general measurement tool established on the unified unidimensional scales, standardized operation protocol to record the continuation, and clinically significant difference of dyspnea variation may be a promising approach. In addition, to evaluate the effect of experimental therapies on dyspnea more precisely, the screening time and blinded assessment are factors that need to be considered.

scholarly journals Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Bernard Cholley ◽  
Bruno Levy ◽  
Jean-Luc Fellahi ◽  
Dan Longrois ◽  
Julien Amour ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trials ◽  
Expert Opinion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Controlled Trials ◽  
Pharmacological Properties ◽  
Ventricular Ejection Fraction ◽  
Randomized Controlled

AbstractDespite interesting and unique pharmacological properties, levosimendan has not proven a clear superiority to placebo in the patient populations that have been enrolled in the various recent multicenter randomized controlled trials. However, the pharmacodynamic effects of levosimendan are still considered potentially very useful in a number of specific situations.Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent the most widely accepted indication. Repeated infusions of levosimendan are increasingly used to facilitate weaning from dobutamine and avoid prolonged hospitalizations in patients with end-stage heart failure, awaiting heart transplantation or left ventricular assist device implantation. New trials are under way to confirm or refute the potential usefulness of levosimendan to facilitate weaning from veno-arterial ECMO, to treat cardiogenic shock due to left or right ventricular failure because the current evidence is mostly retrospective and requires confirmation with better-designed studies. Takotsubo syndrome may represent an ideal target for this non-adrenergic inotrope, but this statement also relies on expert opinion. There is no benefit from levosimendan in patients with septic shock. The two large trials evaluating the prophylactic administration of levosimendan (pharmacological preconditioning) in cardiac surgical patients with poor left ventricular ejection fraction could not show a significant reduction in their composite endpoints reflecting low cardiac output syndrome with respect to placebo. However, the subgroup of those who underwent isolated CABG appeared to have a reduction in mortality. A new study will be required to confirm this exploratory finding.Levosimendan remains a potentially useful inodilator agent in a number of specific situations due to its unique pharmacological properties. More studies are needed to provide a higher level of proof regarding these indications.

scholarly journals B-PO04-046 EFFICACY OF IMPLANTED DEVICE TELEMONITORING IN PATIENTS WITH HEART FAILURE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S297
Author(s):  
Ahmad Al-Abdouh ◽  
Mohammad As Sayaideh ◽  
Ahmad Jabri ◽  
Waiel Abusnina ◽  
Mahmoud Barbarawi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Patients With Heart Failure ◽  
Implanted Device

scholarly journals SGLT 2 INHIBITORS: NEWER PARADIGMS IN THE TREATMENT OF HEART FAILURE WITH REDUCED EJECTION FRACTION

2021 ◽  
Vol 9 (11) ◽  
pp. 1043-1046
Author(s):  
Shaista Alvi
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Randomized Controlled Trials ◽  
Large Scale ◽  
Controlled Trials ◽  
Reduced Ejection Fraction ◽  
Randomized Controlled

Heart Failure is a growing concern now a days. Many drugs are available for the treatment of heart failure but still there is increasing prevalence of heart failure. SGLT 2 inhibitors were initially developed for diabetes mellitus but they are found to be effective for Heart Failure with reduced ejection also. Many large scale randomized controlled trials also confirmed this and now they are recommended in the treatment of heart failure with reduced ejection fraction.

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