From Wiki Journal Club
Jump to: navigation, search

Automated review 2019-02-14T06:07:49


Major points

The treatment of heart failure up until the 1980s focused primarily on symptom control through use of diuretics and digoxin. The effect of the newer class of ACE inhibitors on heart failure was not well understood.

CONSENSUS randomized 253 patients with heart failure and NYHA class IV symptoms to enalapril or placebo in addition to standard medical therapy. The intervention group had a 40% reduction in mortality at 6 months with a NNT of 6. A mortality benefit was subsequently demonstrated by the SOLVD trial (1991) in patients with moderate HF.

ACCF/AHA guidelines recommend use of ACE-inhibitors or ARBs in individuals with heart failure with reduced LVEF (IA[1]). Furthermore, the Joint Commission now rates hospitals on the "core measure" of use of ACE-inhibitors or ARBs at time of discharge in patients with reduced LVEF[2].

Sections missing:

  • Design --> follow up
  • Primary outcome --> NNT (6)
  • Secondary outcome --> NNT (6.25 -- present as 6 or 7?)
  • Subgroup Analysis
  • Adverse Events
  • Funding
  • Additional Links
  1. ACCF/AHA Guidelines
  2. Joint Commission recommendation on use of ACE-inhibitors or ARBs