Efficacy of ACE inhibitors in chronic heart failure with preserved ejection fraction - A meta analysis of 7 prospective clinical studies.
Int J Cardiol. 2011 Apr 9;
Authors: Fu M, Zhou J, Sun A, Zhang S, Zhang C, Zou Y, Fu M, Ge J
BACKGROUND: The effect of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction remains controversial. AIMS: To assess the impact of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction. METHODS AND RESULTS: Seven prospective studies evaluating the effect of ACE inhibitors compared to placebo or other classes of drugs, such as monotherapy or first-line therapy, on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction were included. A total of 2554 patients (mean age: 75.1years, female: 58%) were recruited with an average follow up of 20.9months. The primary etiology of heart failure with preserved ejection fraction was ischemic heart disease (33.7%), hypertension (69.1%) and diabetes mellitus (25.8%). Our results demonstrated that ACE inhibitors significantly reduced all-cause mortality (odds ratio, OR=0.52; 95% Confidence Interval (CI), 0.41 to 0.64; P<0.01). Furthermore, ACE inhibitors were able to reduce heart failure related rehospitalization or treatment over 20.9months (p<0.05) in a subgroup of patients aged over 75years. However, death due to worsening of heart failure, heart failure related rehospitalization and any-cause readmission were not affected (OR=0.88; 95% CI: 0.66 to 1.17; P=0.37 for death due to worsening of heart failure; OR=0.81; 95% CI: 0.63 to 1.05; P=0.11 for heart failure related rehospitalization and OR=0.88; 95% CI: 0.68 to 1.14; P=0.33 for any-cause readmission, respectively). CONCLUSIONS: In patients with chronic heart failure with preserved ejection fraction, ACE inhibitors reduced all-cause mortality without affecting mortality due to heart failure and any-cause rehospitalization.
PMID: 21481482 [PubMed - as supplied by publisher]