From the Guidelines
Medications such as beta-blockers, specifically carvedilol, metoprolol succinate, and bisoprolol, have been proven to improve life span in patients with heart failure with reduced ejection fraction (HFrEF) by reducing morbidity and mortality 1.
Medications Proven to Improve Life Span
The use of these medications is recommended for all patients with current or prior symptoms of HFrEF, unless contraindicated, to reduce morbidity and mortality.
- Beta-blockers have been shown to lessen the symptoms of heart failure, improve the patient’s clinical status, and enhance the patient’s overall sense of well-being.
- Long-term treatment with beta-blockers can reduce the risk of death and the combined risk of death or hospitalization.
- Other medications, such as renin-angiotensin-aldosterone system (RAS) inhibitors, angiotensin receptor-neprilysin inhibitors (ARNI), mineralocorticoid-receptor antagonists (MRAs), and sodium-glucose cotransporter-2 (SGLT2) inhibitors, have also been shown to improve life span in patients with HFrEF 1.
Key Findings
- Quadruple medical therapy for HFrEF, including RAS inhibitors or ARNI, beta-blockers, MRAs, and SGLT2 inhibitors, can reduce the risk of death by 73% over 2 years compared to no treatment.
- Transitioning a patient from traditional dual therapy to quadruple medical therapy can extend life expectancy by 6 years.
- Despite strong clinical trial evidence and guideline recommendations, there continue to be sizeable numbers of patients with HFrEF who are eligible for multiple guideline-directed medical therapies (GDMTs) but do not receive them.
Clinical Implications
- The use of GDMTs, including beta-blockers, RAS inhibitors, ARNI, MRAs, and SGLT2 inhibitors, should be prioritized in patients with HFrEF to improve life span and reduce morbidity and mortality.
- Healthcare providers should strive to implement strategies to improve the use of GDMTs, such as in-hospital initiation, simultaneous or rapid sequence initiation, participation in quality improvement registries, and multidisciplinary titration clinics.
From the Research
Medications Proven to Improve Life Span
- Statins have been shown to improve life span in certain populations, particularly those with cardiovascular risk factors or established atherosclerotic cardiovascular disease 2, 3, 4.
- Studies have demonstrated that statins can reduce the risk of incident heart failure, myocardial infarction, and cardiovascular death in patients with cardiovascular risk factors 2, 3.
- In patients with established heart failure, statins may reduce the rate of heart failure hospitalization and atherosclerotic events, although the evidence is not as strong 2, 3.
- The benefit of statins in improving life span has been observed in various age groups, including those under 40-75, and over 75 years of age 4.
- However, the use of statins in primary prevention has been debated, with some studies suggesting that they may not provide a significant reduction in mortality or ischemic events in healthy patients without cardiovascular disease 5.
- A systematic review and meta-analysis of randomized trials found that statins as a class showed statistically significant risk reductions in non-fatal MI, CVD mortality, all-cause mortality, and composite major cardiovascular events, although they also increased the risk of myopathy, renal dysfunction, and hepatic dysfunction 6.
Specific Statins and Their Effects
- Atorvastatin and rosuvastatin have been shown to be most effective in reducing CVD events, while atorvastatin appeared to have the best safety profile 6.
- The benefit-harm profile of statins differs by statin type, and a quantitative assessment of the benefit-harm balance is needed to inform whether statins provide net benefit 6.