Heart Failure Reviews

, Volume 24, Issue 2, pp 245–254 | Cite as

Autonomic regulation device therapy in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials

  • Ahmed BendaryEmail author
  • Mohamed Bendary
  • Mohamed Salem


Heart failure with reduced ejection fraction (HFrEF) represents a significant public health burden associated with incremental health care costs. Given the limitations associated with pharmacological autonomic regulation therapy (ART), device-based autonomic neuromodulation is on the horizon now for ART in those patients. This systematic review aimed primarily to determine the effect of ART by devices on functional status and quality of life (QOL) in patients with HFrEF. We performed a meta-analysis of five randomized controlled trials (1074 patients) comparing ART by devices versus optimal medical therapy (OMT) in HFrEF. We assessed pooled estimates of odds ratio (OR) for improvement in New York Heart Association (NYHA) class and mean differences (MD) in 6-minute hall walk distance (6-MHWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, N-terminal pro b-type natriuretic peptide (NT-proBNP) levels, and left ventricular end-systolic volume index (LVESVi) with their 95% confidence intervals (CIs) at 6-month follow-up. Compared to OMT alone, ART by devices in HFrEF significantly improves NYHA class (OR 2.26, 95% CI 1.33 to 3.83, P = 0.003), increases 6-MHWD (MD 45.53 m, 95% CI 30.61 to 60.45, P < 0.00001), improves MLHFQ score (MD − 10.59, 95% CI − 20.62 to − 0.57, P = 0.04) with neutral effect on NT-proBNP levels (MD − 236.5 pg/ml, 95% CI − 523.86 to 50.87, P = 0.11) and LVESVi (MD − 1.01 ml/m2, 95% CI − 4.49 to 2.47, P = 0.57). We concluded that device-based neuromodulation therapy significantly improves functional status and quality of life in patients with HFrEF.


Autonomic regulation Devices Heart failure 



6-minute hall walk distance


Autonomic regulation therapy


Confidence interval


Heart failure with reduced ejection fraction


Left ventricular end-systolic volume index


Mean difference


Minnesota Living with Heart Failure Questionnaire


N-terminal pro b-type natriuretic peptide


New York Heart Association


Quality of life



We acknowledge the investigators of the DEFEAT-HF study for providing a corrected figure of NT-proBNP data after they were notified about the erroneous plot in their original published work. A correction has been published by the investigators to reflect this change [33].

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiology Department, Benha Faculty of MedicineBenha UniversityBenhaEgypt
  2. 2.Department of Biostatistics, National Cancer InstituteCairo UniversityGizaEgypt

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