Table 2.
Effectiveness of angiotensin-converting enzyme inibitors (ACEI) in observational studies of heart failure
| Study | Age, years (mean) | No. of patients | Follow-up | Outcome | Relative risk ACEI/No ACEI (odds ratio or hazard ratio) |
|---|---|---|---|---|---|
| I. Effectiveness of ACEI in elderly patients (depressed and preserved LVEF) | |||||
| Havranek et al. (1998) [15] | ≥65 | 328 | 1 year | Mortality | 0.64 (univariate OR) Multivariate analysis – SN |
| Sueta et al. (2000) [16] | ≥65 | 1 195 | 30 days | Mortality or readmission | 0.70 (0.53–0.93) |
| Pulignano et al. (2002) [17] | (63) all >70 | 3 327 1 033 | 1 year | Mortality overall, and in elderly (>70) | 0.73 (0.59–0.89)* 0.75 (0.55–1.01) |
| Ahmed et al. (2003) [18] | ≥65 (79) | 1 090 | 3 years | Mortality | 0.81 (0.69–0.96) |
| Johnson et al. (2003) [19] | ≥65 (79) | 10 638 | 1 year | Mortality | 0.75† |
| II. Effectiveness of ACEI in elderly patients with depressed LVEF | |||||
| Shlipak et al. (2001) [20] | ≥65 | 20 902 | 1 year | Mortality | 0.80 (0.73–0.87)‡ |
| Masoudi et al. (2004) [21] | ≥65 (78) | 17 456 | 1 year | Mortality | 0.86 (0.82–0.90) |
| III. Effectiveness of ACEI in patients with preserved LVEF | |||||
| Philibin et al. (1997) [22] (EF ≥ 40%) | (74) | 350 | 6 months | Mortality Overall readmission | 0.63–NS NS |
| Philibin et al. (2000) [23] (EF ≥ 40%) | (75) | 238 312 | 6 months | Mortality | EF (0.40–0.49); 0.37 (0.17–0.81) EF = 50; 0.61 (0.30–1.25) |
| Overall readmission | NS | ||||
| Dauterman et al. (2001) [24] (EF ≥ 45%) | ≥65 | 430 | 1 year | Mortality HF readmission | 0.87 (0.60–1.27)* NS |
| Ahmed et al. (2002) [25] (EF ≥ 40%) | ≥65 | 200 | 4 years | Mortality | 0.96 (0.65–1.42) |
| Sueta et al. (2003) [26] (EF ≥ 50%) | ≥65 | 760 | 1 year | Mortality | 0.60 (0.42–0.84)* |
| IV. Effectiveness of ACEI per different levels of renal function | |||||
| Philibin et al. (1999) [27] | ≥65 | 1 076 | 6 months | Mortality Mortality or readmission | Cr ≥ 2 mg dl−1; 0.90 (0.43–1.82) Cr < 2 mg dl−1; 0.75 (0.50–1.13) Cr < 2 mg dl−1—SN |
| Frances et al. (2000) [28] | ≥65 | 20 902 | 1 year | Mortality | Cr > 3 mg dl−1; 0.63 (0.48–0.84) Cr ≥ 3 mg dl−1; 0.84 (0.77–0.92) |
| McAlister et al. (2004) [29] | Median 69 | 754 | Median 2.5 years | Mortality | GFR < 60 ml m−1; 0.46 (0.26–0.82) GFR ≤ 60 ml m−1; 0.28 (0.23–0.70) |
| V. Effectiveness of ACEI according to dose used | |||||
| Chen et al. (2001) [30] | ≥65 | 554 | 1 year | Mortality Overall readmission | Target/low; 0.49 (0.29–0.84) Subtarget/low; 0.65 (0.44–0.96) NS |
| Luthi et al. (2002) [31] | ≥65 (77) | 621 | 1 year | Mortality | Target/no ACEI; 0.61 (0.38–0.98)* Target/subtarget; 0.77 (0.51–1.16) |
| Rochon et al. (2004) [32] | ≥65 (78) | 16 539 | 1 year | Mortality Mortality or readmission | Target/low; 0.76 (0.68–0.85) Subtarget/low—similar Low/no ACEI; 0.89 (0.82–0.98)*Target/low dose—SN |
| Luthi et al. (2004) [33] | (75) | 1 634 | 30 days | Readmission | Target/no ACEI—NS Target/less target—NS |
*
Mirrored effect of ACEI, as OR/HR of no ACEI vs. ACEI was reported in the review; SN, significant; NS, nonsignificant; Cr, creatinine; GFR, glomerular filtration rate.
†
Relative risk reduction of ACEI vs. no ACEI or β-blocker (BB) was calculated by dividing adjusted mortality rates in each group.
‡
Relative risk reduction of ACEI vs. no ACEI or BB.