Author(s):
Question:
Setting:
Bibliography:
Certainty assessment№ of patientsEffectCertaintyImportance
№ of studiesStudy designRisk of biasInconsistencyIndirectnessImprecisionOther considerations(üle minna) ARNI ravilejätkata esmavaliku ravimitegaRelative
(95% CI)		Absolute
(95% CI)
Üldsuremus HFrEF
31,2,3
randomised trials
not serious
not serious
not serious
not serious
none
722/4687 (15.4%)
850/4711 (18.0%)
RR 0.86
(0.78 to 0.93)
25 fewer per 1,000
(from 40 fewer to 13 fewer)
⨁⨁⨁⨁
High
OLULINE
Südamepuudulikkusega seotud hospitaliseerimine
31,2,3
randomised trials
not serious
not serious
not serious
not serious
none
575/4687 (12.3%)
724/4711 (15.4%)
RR 0.80
(0.72 to 0.89)
31 fewer per 1,000
(from 43 fewer to 17 fewer)
⨁⨁⨁⨁
High
Kardiovaskulaarsuremus HFrEF
31,2,3
randomised trials
not serious
not serious
not serious
not serious
none
564/4687 (12.0%)
704/4711 (14.9%)
RR 0.81
(0.72 to 0.90)
28 fewer per 1,000
(from 42 fewer to 15 fewer)
⨁⨁⨁⨁
High
Sümptomaatline hüpotensioon
32,3,4
randomised trials
not serious
not serious
not serious
not serious
none
663/4858 (13.6%)
448/4886 (9.2%)
RR 1.49
(1.33 to 1.67)
45 more per 1,000
(from 30 more to 61 more)
⨁⨁⨁⨁
High
Neerufunktsioon langus
62,3,4
randomised trials
not serious
not serious
not serious
not serious
none
221/4858 (4.5%)
267/4886 (5.5%)
RR 0.79
(0.67 to 0.95)
11 fewer per 1,000
(from 18 fewer to 3 fewer)
⨁⨁⨁⨁
High
Oluline hüperkaleemia K>6,0 mmol/L
61,2,3,4,5,6
randomised trials
not serious
not serious
seriousa
not serious
none
261/6722 (3.9%)
343/6731 (5.1%)
RR 0.76
(0.65 to 0.89)
12 fewer per 1,000
(from 18 fewer to 6 fewer)
⨁⨁⨁◯
Moderate
Hüperkaleemia (K >5.5 mmol/l)
32,3,4
randomised trials
not serious
not serious
not serious
not serious
none
762/4858 (15.7%)
798/4886 (16.3%)
RR 1.04
(0.84 to 1.29)
7 more per 1,000
(from 26 fewer to 47 more)
⨁⨁⨁⨁
High
Angioödeem
52,3,4,5,6
randomised trials
not seriousb
not serious
seriousa
not serious
none
35/7414 (0.5%)
21/7427 (0.3%)
RR 1.42
(0.52 to 3.87)
1 more per 1,000
(from 1 fewer to 8 more)
⨁⨁⨁◯
Moderate
NYHA klass
27,8
observational studies
not serious
not serious
not serious
seriousc
none
293
293
-
mean 0.82 NYHA klass lower
(0.91 lower to 0.72 lower)
⨁◯◯◯
Very low
Füüsiline võimekus (assessed with: 6 MKT)
79,10,11,12,13,14,15,d
observational studies
not serious
seriouse
not serious
seriousf
none
325
325
-
MD 27.62 m higher
(39.48 higher to 15.76 higher)
⨁◯◯◯
Very low

CI: confidence interval; MD: mean difference; RR: risk ratio

Explanations

a. Analüüsi olid kaasatud ka HFpEF patsiendid (PARAMOUNT-HF ja PARAGON-HF)
b. 68,3 % metaanalüüsi kaasatud patsientidest olid enne randomiseerimist läbinud run-in perioodi. Randomiseeriti ainult need patsiendid, kes talusid run-in perioodi jooksul ravi AKE/ARB + ARNI-ga.
c. Kaks uuringut, milles vähe patsiente (250 ja 43)
d. Wang jt 2019.aasta metaanalüüsi kaasati 7 kohortuuringu andmeid
e. I2 = 55%
f. Väikese patsientide arvuga uuringud

References

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