Evidence map›Paper›PMID 40254722›Full record

SynthesisEuropean journal of heart failure2025

Minimization or withdrawal of oral pharmacotherapy in chronic heart failure patients with improved myocardial function: A systematic review.

Yuxiang Luo, Wenbin Xiao, Yusuf Z Sener, Wouter C Meijers, Robert M A van der Boon, Elfatih A Hasabo, Osama Soliman, Rudolf A de Boer, Kadir Caliskan

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European journal of heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–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

2 citing papers in PubMed.

  1. Trial
  2. Article
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

9 authors.

Yuxiang LuoThoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Wenbin XiaoDepartment of Cardiothoracic Surgery, Chongqing University Central Hospital, Chongqing, China.
Yusuf Z SenerThoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Wouter C MeijersThoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Robert M A van der BoonThoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Elfatih A HasaboRoyal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
Osama SolimanRoyal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
Rudolf A de BoerThoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Kadir CaliskanThoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.ORCID https://orcid.org/0000-0001-7794-5991

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsThe necessity of lifelong treatment and polypharmacy in chronic heart failure (HF) patients with improved myocardial function remains debated. This systematic review aims to synthesize current literature regarding this issue. METHODS AND

resultsA systematic literature search was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from the inception to 18 October 2024. Seven studies (n = 552) reporting minimization or withdrawal of pharmacotherapy in chronic HF patients with improved ejection fraction or stable New York Heart Association status were included. Findings were heterogeneous due to variations in study design and protocols. Loop diuretic withdrawal was favoured by one non-randomized study (n = 26) and one randomized controlled trial (RCT) (n = 188). Minimization of angiotensin receptor-neprilysin inhibitors (n = 77) or withdrawal of mineralocorticoid receptor antagonists (MRA) (n = 70) was not favourable. Carvedilol monotherapy was favoured by one small-sample RCT (n = 60). One RCT (n = 51) reported a high overall relapse rate (65%) following multiple drug withdrawal in recovered patients with dilated cardiomyopathy. Another RCT (n = 80) found a low occurrence of cardiac dimensional deterioration (7.5%) following multiple drug withdrawal in post-cardiac resynchronization therapy patients with normalized ejection fraction. However, 28% required drug re-initiation due to cardiac comorbidities.

conclusionThe existing evidence on minimizing or withdrawing oral pharmacotherapy in chronic HF patients with improved myocardial function remains very limited and heterogeneous, supporting only loop diuretic withdrawal and possibly carvedilol monotherapy, but not the minimization or withdrawal of renin-angiotensin system inhibitors, MRA, or the combination of HF medications. Large RCTs are needed to determine the appropriate treatment strategy.

Indexed as

Heart FailureStroke VolumeWithholding TreatmentAdministration, OralAngiotensin Receptor AntagonistsChronic DiseaseHumansMineralocorticoid Receptor AntagonistsAngiotensin Receptor AntagonistsMineralocorticoid Receptor AntagonistsDrug therapyDrug withdrawalGuideline‐directed medical therapyHeart failureSystematic reviewTreatment interruption

Identifiers

PMID40254722
PMCPMC12803621

What OpenQuestion holds

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Registered trials

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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.