Key result
ACE inhibitor use is linked to ~9% lower LVEF than non-users alongside variable, sub-optimal dosing.
Cross-Sectional (n=157)
No
Mean Difference: 8.6 (95% CI 5.84–11.46)
Absolute Event Rate: 26% vs 34.6%
p-value: p=<0.01
Suboptimal ACEI dosing in specialist HF clinics should not yet change practice; leaves open whether non-clinical factors drive under-titration.
Large studies have shown improved survival of patients with heart failure1 2 and of those recovering from acute myocardial infarction3 4 after treatment with high doses of angiotensin converting enzyme inhibitors. We studied the usage of angiotensin converting enzyme inhibitors for chronic heart failure in a tertiary referral centre to investigate the relation between the regimen used and patient variables and how this related to the dosages used in the published mortality trials. We examined the drug regimens of 157 patients seen by two consultants in a specialist clinic for chronic heart failure. Chronic heart failure was diagnosed from the finding of impaired left ventricular function on echocardiography, radionuclide ventriculography, or cardiac catheterisation. All patients underwent exercise testing with metabolic gas exchange measurements. All had been reviewed at …
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Clark et al. (1995) conducted a cross-sectional in Chronic heart failure (n=157). Angiotensin converting enzyme inhibitors vs. No angiotensin converting enzyme inhibitor was evaluated on Mean left ventricular ejection fraction (MD 8.6, 95% CI 5.84 to 11.46, p=<0.01). Patients taking ACE inhibitors had lower mean left ventricular ejection fraction (26.0% vs 34.6%) than non-users, but clinical variables did not influence the widely varying, often sub-optimal doses.
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