Effect of ACE inhibitors on the quality of life of patients with heart failure

The physiologic effects of ACE inhibitors often result in symptomatic relief in patients with heart failure and prevention of episodes of decompensated heart failure and ischemic events in some patients. It is important to determine if these effects, in conjunction with all other aspects of ACE inhibitor treatment, favorably alter quality of life as judged by the patients. Questionnaires that allow patients to rate the effects of heart failure and treatments on their lives have been used in some controlled clinical trials. The available data suggest that symptomatic patients have a limited quality of life than can be improved by ACE inhibitors. In addition, it seems reasonable to assume that avoidance of episodes of decompensated heart failure and ischemic events would have some yet-to-be-defined effect on maintenance of patients' quality of life. However, the proportion of patients who experience these preventive effects during a few years of follow-up may be too small to document an effect on quality of life in the overall population with mild heart failure or asymptomatic left ventricular dysfunction. The high mortality rate associated with heart failure makes it difficult to study quality of life over prolonged periods of time. One investigation [18] has suggested that quality of life progressively deteriorates in survivors over 2 to 4 years despite administration of ACE inhibitors. This finding is consistent with the natural history of heart failure, although there are insufficient placebo-controlled data to determine whether ACE inhibitors can delay the long-term progressive decline in quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)