Comparing Glucagon-Like Peptide-1 Receptor Agonists to Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure With Preserved Ejection Fraction: A Systematic Review
Notice bibliographique
Résumé
Heart failure with preserved ejection fraction (HFpEF) is a subtype of congestive heart failure distinguished by a normal ejection fraction. Comorbidities associated with its development typically include chronic conditions such as diabetes, hypertension and obesity that restrict the heart's filling pressure. Since heart failure with reduced ejection fraction (HFrEF) has been the subject of much research, physicians have always been faced with the problem of a lack of effective therapeutic interventions when treating patients with HFpEF. In recent years, there has been an increase in the number of research studies to identify effective therapeutic medication for HFpEF. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, which were initially developed to manage diabetes, have shown improvement in clinical outcomes in HFpEF even in the absence of diabetes. This systematic review aimed to gather and analyze evidence from randomized controlled trials and observational studies on the two drug classes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed in the conduct of this comprehensive systematic review. To find all relevant studies, we searched three major medical databases, including Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed (NCBI). We have identified 13 studies on both classes of drugs, some of which have contributed to formulating current guidelines for managing HFpEF. The quality of included studies has been scrutinized using quality assessment tools, including the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale tool, to ensure transparency and limit bias to lead to more reliable findings. Most studies on SGLT-2 inhibitors demonstrated a significant reduction in hospitalization rates and symptom burden, as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and functional capacity, as measured by a 6-minute walk test distance. GLP-1 receptor agonists have also improved symptom scores and functional capacity, specifically in obese patients, although reductions in hospitalization rates remain unclear. Improvements in functional capacity and symptom scores were observed for both drug classes, though some metrics were not consistently statistically significant across studies. The superiority of one medication over another remains inconclusive due to a lack of trials comparing both drugs. In addition, GLP-1 receptor agonists have been more recently studied, necessitating further research on this drug class to assess long-term outcomes, efficacy in non-obese patients, and combination with SGLT-2 inhibitors.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,026 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,016 | 0,015 |
| Bibliométrie | 0,007 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».