Pentoxifylline for heart failure: A systematic review

 

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dc.contributor.author Batchelder, Kathryn
dc.contributor.author Mayosi, Bongani M
dc.date.accessioned 2017-04-11T06:27:20Z
dc.date.available 2017-04-11T06:27:20Z
dc.date.issued 2005
dc.identifier.citation Batchelder, K., & Mayosi, B. M. (2005). Student paper: pentoxifylline for heart failure: a systematic review: original article. South African Medical Journal, 95(3), p-171.
dc.identifier.uri http://hdl.handle.net/11427/24176
dc.description.abstract Background. Recent trials have indicated a beneficial effect of pentoxifylline on measures of inflammation and markers of cardiac dysfunction in people with heart failure. However, it is uncertain whether pentoxifylline should be used routinely in the management of heart failure. Objective. To determine the effectiveness of pentoxifylline in heart failure. Design. Systematic review of randomised controlled trials. Methods. We searched MEDLINE (1 January 1966 - 20 November 2004), the Cochrane Controlled Trials Register (issue 4, 2004), and reference lists of related papers, for randomised controlled trials of pentoxifylline in the treatment of heart failure. Prospective, randomised, double-blind controlled trials were sought for inclusion in the study. The two reviewers independently assessed trial quality and extracted data, which were analysed using RevMan statistical software. The following outcome measures were evaluated: (i) New York Heart Association (NYHA) functional class; (ii) left ventricular ejection fraction (LVEF); (iii) frequency of hospitalisation; and (iv) death from all causes. Results. Four studies with a total of 144 participants met the inclusion criteria. Statistical pooling (or meta-analysis) was not performed owing to the significant clinical heterogeneity and differences in reporting of the outcomes in the included studies; instead, the trials were analysed separately for the outcomes of interest. The four studies tested the use of pentoxifylline versus placebo in patients with heart failure of varying aetiology (idiopathic dilated cardiomyopathy, 3 studies; ischaemic cardiomyopathy, 1 study). In 2 of the idiopathic dilated cardiomyopathy studies, patients were classified as NYHA class II or III, while the study population in another idiopathic cardiomyopathy study was in NYHA class IV. The trial of patients with ischaemic cardiomyopathy included patients in NYHA functional classes I - IV. The use of pentoxifylline was associated with significant improvement in symptoms (i.e. NYHA functional class) and cardiac function (i.e. LVEF) in 3 out of 4 studies. The beneficial effect on symptoms of heart failure and cardiac function was seen in all grades of severity of heart failure and in patients with ischaemic and idiopathic dilated cardiomyopathy. All 4 studies showed a trend towards reduction of mortality, but this effect was not statistically significant. The effect of pentoxifylline on the frequency of hospitalisation has not been tested in randomised controlled trials. Interpretation. Pentoxifylline may have a beneficial effect on NYHA functional class, ejection fraction and mortality in heart failure, but published trials are too small to provide conclusive evidence. There is a need for large, placebocontrolled trials of pentoxifylline in heart failure, involving a diverse group of patients with regard to cause and severity of heart failure.
dc.language.iso eng
dc.source South African Medical Journal
dc.source.uri http://www.samj.org.za/index.php/samj
dc.title Pentoxifylline for heart failure: A systematic review
dc.type Journal Article en_ZA
dc.date.updated 2016-01-05T10:02:40Z
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Batchelder, K., & Mayosi, B. M. (2005). Pentoxifylline for heart failure: A systematic review. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/24176 en_ZA
dc.identifier.chicagocitation Batchelder, Kathryn, and Bongani M Mayosi "Pentoxifylline for heart failure: A systematic review." <i>South African Medical Journal</i> (2005) http://hdl.handle.net/11427/24176 en_ZA
dc.identifier.vancouvercitation Batchelder K, Mayosi BM. Pentoxifylline for heart failure: A systematic review. South African Medical Journal. 2005; http://hdl.handle.net/11427/24176. en_ZA
dc.identifier.ris TY - Journal Article AU - Batchelder, Kathryn AU - Mayosi, Bongani M AB - Background. Recent trials have indicated a beneficial effect of pentoxifylline on measures of inflammation and markers of cardiac dysfunction in people with heart failure. However, it is uncertain whether pentoxifylline should be used routinely in the management of heart failure. Objective. To determine the effectiveness of pentoxifylline in heart failure. Design. Systematic review of randomised controlled trials. Methods. We searched MEDLINE (1 January 1966 - 20 November 2004), the Cochrane Controlled Trials Register (issue 4, 2004), and reference lists of related papers, for randomised controlled trials of pentoxifylline in the treatment of heart failure. Prospective, randomised, double-blind controlled trials were sought for inclusion in the study. The two reviewers independently assessed trial quality and extracted data, which were analysed using RevMan statistical software. The following outcome measures were evaluated: (i) New York Heart Association (NYHA) functional class; (ii) left ventricular ejection fraction (LVEF); (iii) frequency of hospitalisation; and (iv) death from all causes. Results. Four studies with a total of 144 participants met the inclusion criteria. Statistical pooling (or meta-analysis) was not performed owing to the significant clinical heterogeneity and differences in reporting of the outcomes in the included studies; instead, the trials were analysed separately for the outcomes of interest. The four studies tested the use of pentoxifylline versus placebo in patients with heart failure of varying aetiology (idiopathic dilated cardiomyopathy, 3 studies; ischaemic cardiomyopathy, 1 study). In 2 of the idiopathic dilated cardiomyopathy studies, patients were classified as NYHA class II or III, while the study population in another idiopathic cardiomyopathy study was in NYHA class IV. The trial of patients with ischaemic cardiomyopathy included patients in NYHA functional classes I - IV. The use of pentoxifylline was associated with significant improvement in symptoms (i.e. NYHA functional class) and cardiac function (i.e. LVEF) in 3 out of 4 studies. The beneficial effect on symptoms of heart failure and cardiac function was seen in all grades of severity of heart failure and in patients with ischaemic and idiopathic dilated cardiomyopathy. All 4 studies showed a trend towards reduction of mortality, but this effect was not statistically significant. The effect of pentoxifylline on the frequency of hospitalisation has not been tested in randomised controlled trials. Interpretation. Pentoxifylline may have a beneficial effect on NYHA functional class, ejection fraction and mortality in heart failure, but published trials are too small to provide conclusive evidence. There is a need for large, placebocontrolled trials of pentoxifylline in heart failure, involving a diverse group of patients with regard to cause and severity of heart failure. DA - 2005 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2005 T1 - Pentoxifylline for heart failure: A systematic review TI - Pentoxifylline for heart failure: A systematic review UR - http://hdl.handle.net/11427/24176 ER - en_ZA


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