Meta-analysis of sacubitril-valsartan versus renin-angiotensin-aldosterone system inhibitors in the treatment of elderly refractory heart failure
Objective To systematically evaluate the efficacy and safety of sacubitril-valsartan(ARNI)compared to angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists(ACEI/ARB)in the treatment of elderly refrac-tory heart failure patients.Methods The literatures were obtained in Cochrane Library,Embase,PubMed,Web of science and Chinese databases(CNKI,WanFang,VIP and CBM).After literature screening and data extraction,the quality of the included literature was evaluated using the Cochrane bias risk assessment tool.Meta analysis was conducted using RevMan and Stata software.Results A total of 10 literatures were included,with a total of 1 118 elderly refractory heart failure pa-tients including.Meta-analysis results showed that the N-terminal proBNP(NT-proBNP)(MD =-282.61,95％CI-344.56～-220.66,P<0.05),the left ventricular end-diastolic diameter(LVEDD)(MD=-3.48,95％CI-4.58～-2.39,P<0.05)in the study group were lower than those in the control group;the left ventricular ejection fraction(LVEF)(MD= 6.13,95％CI 5.15～7.11,P<0.05)and effective rate(OR= 2.548,95％CI 2.058～3.154,P<0.05)were significantly higher than those in the control group,respectively.The left ventricular ejection fraction(LVEF)(MD=6.35,95％CI 4.65～8.06,P<0.05)and effective rate(OR=2.449,95％CI 1.851～3.241,P<0.05)were significantly higher than those in the control group.In terms of adverse reactions,there was no difference in renal function damage,dizzy and hyperkalemia be-tween the two groups,and the incidence of hypotension in the study group was lower than that in the control group.ConcIu-sion Compared with ACEI/ARB,sacubitril-valsartan can significantly improve cardiac function,improve ventricular re-modeling,and reduce myocardial tissue damage in elderly patients with refractory heart failure without significant adverse re-actions.
Refractory heart failureElderlySacubitril-valsartanRenin-angiotensin-aldosterone system inhibitorsMeta-analysis
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