Effect of angiotensin-converting enzyme inhibition on functional class in patients with left ventricular systolic dysfunction

ACE inhibitors appear to be effective in improving symptoms (measured as NYHA class) in patients with chronic heart failure.

A systematic review including 20 studies (three individual patient data studies and one other long-term study (n=10,908 at follow-up) and 16 short-term studies of patients with chronic HF (3 months' follow-up; n=2,302)) was abstracted in DARE. In the large long-term studies, treatment with ACE inhibitors was associated with a significantly reduced risk of being in NYHA class II-IV compared with class I (OR 0.875, 95% CI: 0.811 to 0.943, P=0.0005). ACE inhibitors were associated with a significantly reduced risk of being in NYHA class II-IV compared with class I only in studies that included patients with chronic HF (OR 0.66, 95% CI: 0.52 to 0.84, P=0.001; based on two studies); the risk reduction was not significant in studies of patients with acute MI (based on two studies). In the short-term studies, patients treated with ACE inhibitors were significantly more likely to show an improvement of at least one NYHA class (random-effects OR 2.11, 95% CI: 1.48 to 2.98, P<0.0001; significant statistical heterogeneity was present).

Comment: The quality of evidence is downgraded by poor reporting of the methodology of the included studies.

The following decision support rules contain links to this evidence summary:

• ACEI/ARB and beta-blockers for patients with congestive heart failure

Ədəbiyyat

1. Abdulla J, Abildstrom SZ, Christensen E, Kober L, Torp-Pedersen C. A meta-analysis of the effect of angiotensin-converting enzyme inhibitors on functional capacity in patients with symptomatic left ventricular systolic dysfunction. Eur J Heart Fail 2004 Dec;6(7):927-35.