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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

Insights

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.

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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