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Rationalizing the heart failure trials: from theory to practice

A D Struthers1

  • 1Department of Clinical Pharmacology, Ninewells Hospital, Dundee, UK.

European Heart Journal
|December 24, 1997
PubMed
Summary

Angiotensin-converting enzyme (ACE) inhibitors remain the most effective treatment for improving mortality in heart failure patients. Despite proven benefits, their clinical use is limited by concerns about side effects.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • The CONSENSUS I study, 10 years ago, established Angiotensin-converting enzyme (ACE) inhibitors as beneficial for heart failure mortality.
  • Subsequent trials like SOLVD and SAVE have confirmed these findings, highlighting ACE inhibitors' consistent efficacy.

Purpose of the Study:

  • To review the established efficacy of ACE inhibitors in heart failure mortality.
  • To investigate the persistent underutilization of ACE inhibitors in clinical practice despite their proven benefits.

Main Methods:

  • Review of landmark clinical trials (e.g., CONSENSUS I, SOLVD, SAVE) evaluating heart failure therapies.
  • Analysis of potential reasons for the under-use of ACE inhibitors in current medical practice.

Main Results:

  • ACE inhibitors demonstrate superior mortality benefits in heart failure compared to other examined therapies, including digoxin, amlodipine, beta-blockers, and amiodarone.
  • Despite strong evidence, ACE inhibitors are underused in heart failure management.

Conclusions:

  • ACE inhibitors are a cornerstone therapy for improving heart failure outcomes.
  • Addressing clinical inertia and patient/physician concerns regarding side effects like hypothermia and renal dysfunction is crucial for increasing ACE inhibitor adoption.

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