Key result
ACEIs reduce all-cause mortality ~11% in heart failure while ARBs show no survival benefit.
Why the study?
Do ACEIs and ARBs reduce all-cause and cardiovascular mortality in patients with heart failure?
Population
47,662 patients with heart failure with reduced ejection fraction (HFrEF, LVEF ≤45%) pooled from 38 RCTs
Comparison
Angiotensin-converting enzyme inhibitors or… vs Placebo, no treatment, or active treatment
Design
Meta-analysis
Follow-up
mean/median 12 weeks to 4.5 years
Authors
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Supports prioritizing ACEIs over ARBs for mortality reduction in HF; confirms class-specific effects and extends prior trial evidence.
Meta-Analysis (n=47,662)
Do ACEIs and ARBs reduce all-cause and cardiovascular mortality in patients with heart failure?
Effect estimate: RR 0.89 (95% CI 0.83-0.96)
p-value: p=0.001
In patients with heart failure, ACEIs, but not ARBs, significantly reduce all-cause and cardiovascular mortality, supporting ACEIs as first-line therapy.
Tai et al. (2017) conducted a meta-analysis in Heart failure with reduced ejection fraction (n=47,662). Angiotensin-converting enzyme inhibitors (ACEIs) vs. Placebo, no treatment, or active treatment was evaluated on All-cause mortality (RR 0.89, 95% CI 0.83-0.96, p=0.001). ACEIs significantly reduced all-cause mortality by 11% (RR 0.89) and cardiovascular mortality by 14% (RR 0.86) in patients with heart failure, whereas ARBs showed no significant mortality benefit.
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