Abstract 16320: A Network Meta-Analysis and Diversity-Adjusted Trial Sequential Analysis of Angiotensin Converting Enzyme Inhibitors in Patients With Heart Failure: Evidence of Class Effect
Background: Angiotensin converting enzyme inhibitors (ACEIs) represent a mainstay in the management of heart failure. However, it remains unclear if any particular ACEI is superior to the others or benefits of these agents are mainly due to class effect.
Methods: Randomized trials comparing ACEI versus placebo or other treatments were systematically searched in MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials. The primary end-point was all cause death at the longest available follow-up assessed with odds ratios (OR) and Bayesian random-effect 95% credible intervals, with independent extraction by observers.
Results: A total of 10 trials were included. As expected, at overall analysis ACEIs provided credible mortality benefits of 19% in comparison to placebo or comparator after a median of 30 months (OR=0.81 [0.76-0.88]; p<0.01, without heterogeneity). Trial sequential analysis (TSA) confirmed the validity of our findings. However, no credible differences were found when comparing head-to-head the different ACEIs for the risk of death, sudden cardiac death, death due to pump failure, rehospitalizations or drug discontinuation.
Conclusions: Benefits of ACEI in patients with heart failure appear to be due to a class effect. There is currently no statistical evidence in support of the superiority of any single agent over the others.
- © 2013 by American Heart Association, Inc.