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Response by Tseng et al to Letter Regarding Article, "Efficacy of Pharmacologic and Cardiac Implantable Electronic Device Therapies in Patients With Heart Failure and Reduced Ejection Fraction: A Systematic Review and Network Meta-Analysis".

August 2019 1 Andrew S. Tseng, MD Katie L. Kunze, PhD Siva K. Mulpuru, MD In Response: We greatly appreciate the commentary by Zamani and Wininger in regard to our recent network meta-analysis on pharmacological and cardiac implantable electronic device therapies in heart failure with reduced ejection fraction.1 Their response to our article was meticulous and insightful, and we are privileged to be able to respond to their concerns. We agree with the commentators on the limitations of our design for Figure 6 and acknowledge errors in its construction. Figure 6 attempts to visually represent the temporal relationship between the number of pharmacological versus device studies and mean all-cause mortality incidence rates. We did not intend for Figure 6 to answer the question on overall comparative efficacy of medications versus devices in reducing all-cause mortality. The sole purpose of this supporting figure is to visually demonstrate the trend of all-cause mortality rates in heart failure trials over time. To more accurately represent the data and our intentions with this figure, we have revised the figure to be a bubbleplot, weighted by study sample size and study duration (in person-years). We also thank the commentators for mentioning the misattribution of the study years with the publication years, and we have rectified this in our new figure. Regrettably, Figure 6 had included additional studies from an older version of the data, and in the final publication, Figure 6 had not been updated to reflect only those studies included in the final analysis. All other figures and analyses in the article were derived from the final data. The revised figure is provided here and online (Figure). The raw data used to construct the figure have been provided online (https://drive.google.com/drive/folders/15YnklLuvORw 0oYSPLOcSYMk2WAuuAeGL?usp=sharing). Overall, our study is intended to assist clinicians and researchers generate hypotheses for the various roles of medications and devices in the treatment of heart failure with reduced ejection fraction. We thank the commentators for their thoughtful analysis and comments and believe that the revised figure more accurately represents the data and the intended scope of the figure.