Network meta-analysis on efficacy of nerve stimulation or modulation in patients with heart failure

Background: Dysfunction of the autonomic nervous system (characterized by excessive sympathetic activation and reduced parasympathetic activity) is regarded as 1 of the primary mechanisms of heart failure. Theoretically, nerve stimulation or modulation targeting this autonomic imbalance could improve outcomes in heart failure, but current evidence is inconclusive. Objective: This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of various nerve stimulation/modulation approaches in patients with heart failure. Methods: We conducted a frequentist-based NMA of randomized controlled trials (RCTs) investigating nerve stimulation or modulation techniques for heart failure management. The primary outcomes included objective measures (such as brain natriuretic peptide [BNP] serum levels) and subjective measures (such as psychosocial functioning and quality of life). Results: Interventions targeting both arms of the autonomic nervous system, including sympathetic and parasympathetic nervous systems, and the vasculature (carotid or renal arteries) demonstrated preferable results. Interventions dealing only with the autonomic nervous system did not provide significant results. Specifically, only renal sympathetic denervation was significantly associated with a more significant reduction in BNP levels than in the control group. Additionally, baroreflex activation therapy was the only treatment significantly associated with improving quality of life. Conclusion: This study provides comparative evidence supporting the use of specific nerve stimulation/modulation techniques in treating heart failure. Further well-designed RCTs, incorporating appropriate blinding, are recommended to minimize potential biases.