Evidence map›Paper›PMID 39285726›Full record

SynthesisBritish journal of clinical pharmacology2025

The effect of down-titration and discontinuation of heart failure pharmacotherapy in older people: A systematic review and meta-analysis.

Mai H Duong, Danijela Gnjidic, Andrew J McLachlan, Mitchell R Redston, Parag Goyal, Stephanie Mathieson, Sarah N Hilmer

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Review
  6. Article
  7. Article
  8. Decongestion in chronic heart failure.JRSM cardiovascular disease
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Mai H DuongKolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia.ORCID https://orcid.org/0000-0002-6764-3233
Danijela GnjidicSydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID https://orcid.org/0000-0002-9404-3401
Andrew J McLachlanSydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID https://orcid.org/0000-0003-4674-0242
Mitchell R RedstonSt George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.ORCID https://orcid.org/0000-0002-3728-6351
Parag GoyalProgram for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.ORCID https://orcid.org/0000-0001-7474-3737
Stephanie MathiesonSydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID https://orcid.org/0000-0002-7335-8842
Sarah N HilmerKolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia.ORCID https://orcid.org/0000-0002-5970-1501

Funding

U.S. Deprescribing Research NetworkR24AG064025 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI BOYD, CYNTHIA MELINDA, STEINMAN, MICHAEL A. · 2019 to 2023
$9.9M
A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and PolypharmacyK76AG064428 · NIA · WEILL MEDICAL COLL OF CORNELL UNIV · PI GOYAL, PARAG · 2020 to 2024
$1.1M
American Heart Association 20CDA35310455Commonwealth of Australia National Health and Medical Research Council APP1191018Heart Research Australia Postgraduate Scholarship 2023/2024NIA NIH HHS K76 AG064428NIA NIH HHS K76AG064428NIA NIH HHS R24 AG064025NIA NIH HHS R24AG064025University of Sydney
6 · The paper itself

Abstract

The aim of this study was to investigate whether interventions to discontinue or down-titrate heart failure (HF) pharmacotherapy are feasible and associated with risks in older people. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Electronic databases were searched from inception to 8 March 2023. Randomized controlled trials (RCTs) and observational studies included people with HF, aged ≥50 years and who discontinued or down-titrated HF pharmacotherapy. Outcomes were feasibility (whether discontinuation or down-titration of HF pharmacotherapy was sustained at follow-up) and associated risks (mortality, hospitalization, adverse drug withdrawal effects [ADWE]). Random-effects meta-analysis was performed when heterogeneity was not substantial (Higgins I

Indexed as

Heart FailureAgedHospitalizationHumansMiddle AgedObservational Studies as TopicRandomized Controlled Trials as Topiccardiovascular pharmacologyclinical pharmacologyepidemiologymedication safetyevidence‐based medicinegeriatric medicinegeriatrics

Identifiers

PMID39285726
PMCPMC11671334

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.