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. 2021 Mar;23(3):420-431.
doi: 10.1002/ejhf.2103. Epub 2021 Mar 22.

Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades

Antoine Kimmoun  1   2 , Koji Takagi  2 , Emmanuel Gall  3 , Shiro Ishihara  2   4 , Pierre Hammoum  5 , Nathan El Bèze  6 , Alexandre Bourgeois  1 , Guillaume Chassard  1 , Hugo Pegorer-Sfes  1 , Etienne Gayat  2   5 , Alain C Solal  2   3 , Alexa Hollinger  2   7 , Thomas Merkling  8 , Alexandre Mebazaa  2   5 ; METAHF Team
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Free article

Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades

Antoine Kimmoun et al. Eur J Heart Fail. 2021 Mar.
Free article

Abstract

Aims: Acute heart failure (AHF) is frequent and life-threatening disease. However, innovative AHF therapies have remained limited, and care is based on experts' opinion. Temporal trends and benefits of long-term oral cardiovascular medications on AHF outcomes remain uncertain.

Methods and results: This study is registered with PROSPERO (CRD42018099885). A systematic review ranging from 1980 to 2017, searched AHF studies with more than 100 patients that reported death and/or readmission. Primary outcomes were temporal trends, assessed by meta-regression, for 30-day or 1-year all-cause death and/or readmission rates. Secondary outcomes were temporal trends of oral cardiovascular therapies and their influence on primary outcomes. Among the 45 143 studies screened, 285 were included, representing 15 million AHFs. In the past decades, though mortality and readmission remain high, there was a decline in 30-day all-cause death [odds ratio (OR) for a 10-year increment: 0.74, 95% confidence interval (CI) 0.61-0.91; P = 0.004] that persisted at 1 year (OR 0.86, 95% CI 0.77-0.96; P = 0.007), while 30-day and 1-year all-cause readmission rate remained roughly unchanged. Trends of primary outcomes were linear and did not differ among continents. Decline in 1-year all-cause death rate correlated with high proportions of oral or beta-blockers, especially when combined with oral renin-angiotensin-aldosterone system inhibitors, but not with diuretics while trends in readmission remained unchanged with these therapies.

Conclusions: Although AHF outcomes remain poor, the present study revealed global favourable trends of survival after AHF episodes probably associated with greater use of oral neurohormonal antagonists. The present study urges to implement the combination of oral renin-angiotensin-aldosterone system inhibitors and beta-blockers in patients at risk of AHF.

Keywords: Acute heart failure; Meta-analysis; Outcomes; Systematic review.

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