Can medications be safely withdrawn in patients with stable chronic heart failure? systematic review and meta-analysis

Background Heart failure (HF) therapy involves use of multiple medications. There is little guidance on the safety and impact on clinical outcomes of stopping HF medications. Methods Comprehensive systematic search for studies of drug therapy withdrawal in HF. Meta-analysis of the risk ratio (RR) using the Mantel-Haenszel random effects model for all-cause mortality and cardiovascular outcomes. Results Twenty-six studies met inclusion criteria. Studies on withdrawal of RAAS inhibitors and beta-blockers in HF are scarce and small, however show relatively convincingly that such withdrawals will have untoward effects on cardiac structure, symptoms and major outcomes. Meta-analysis of seven studies of digoxin withdrawal (2987 participants) without background beta-blocker showed increased HF hospitalisations (RR 1.30, 95 confidence interval 1.16, 1.46 p