Beta-blockers, anti-aldosterones, and combined angiotensin receptor blocker (ARB)/neprilysin inhibitors were found to be effective for reducing sudden cardiac death (SCD) events in patients with heart failure and reduced ejection fraction (HFrEF), according to a review published in BMJ Open.

For this study, researchers searched multiple databases for studies in which the effectiveness of various pharmacologic interventions were evaluated in patients with HFrEF. They identified 41 reviews that included treatments such as beta-blockers, angiotensin-converting enzyme inhibitors (ACE-i), ARBs, anti-aldosterones or mineralocorticoid-receptor antagonists, amiodarone, other antiarrhythmics, combined ARB/neprilysin inhibitors, statins, and fish oil supplements.

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Results showed that beta-blockers (odds ratio [OR] 0.69 for SCD; 0.67 for all-cause mortality), anti-aldosterones (risk ratio [RR] 0.81 for SCD; 0.81 for all-cause mortality), and combined ARB/neprilysin inhibitors (RR 0.81 for SCD; 0.86 for all-cause mortality) were effective in preventing SCD and all-cause mortality, while ACE-i significantly reduced all-cause mortality but not SCD events (OR 0.91).

Moreover, neither ARBs nor statins appeared to be effective for reducing SCD or all-cause mortality. The evidence for the efficacy of omega-3 fatty acids and antiarrhythmics was considered uncertain due to either conflicting or inconclusive evidence. Specifically, amiodarone demonstrated a significant reduction in SCD events but not in all-cause mortality in newer studies, but a decline in both endpoints in older reviews. 

“Our overview indicates that only three drug interventions (beta-blockers, anti-aldosterones, combined ARB/neprilysin inhibitors) significantly reduce SCD and improve overall survival among individuals with HF and reduced ejection fraction,” concluded the authors. “This categorization could help health professionals and patients making evidence-based decisions based on updated knowledge, particularly whenever a high-risk SCD patient is identified.” 

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