6. What is the effect of other medical interventions in other groups of patients with asymptomatic cardiomyopathy?
First Author Year	Study Design Treatment era Years of follow-up	Participants	Treatment	Main outcomes	Addt’l remarks
Konstam67 2000	Double-blind, placebo-controlled RCT Median follow-up 555 days.	3152 patients aged 60 years or older with New York Heart Association class II–IV heart failure and LVEF ≤40%	losartan (n=1578) titrated to 50 mg once daily or captopril (n=1574) titrated to 50 mg three times daily	all-cause mortality: 11·7 vs 10·4% average annual mortality rate HR 1·13 [95·7% CI 0·95–1·35], p=0·16 sudden death or resuscitated arrests: 9·0 vs 7·3% HR 1·25 [95% CI 0·98–1·60], p=0·08	Significantly fewer patients in the losartan group (excluding those who died) discontinued study treatment because of adverse effects (9·7 vs 14·7%, p<0·001), including cough (0·3 vs 2·7%)
Hunt61,62 AHA/ACC Guideline (2005 and 2009)	Angiotensin II receptor blockers can be useful to prevent HF in patients at high risk for developing HF	Stage A* who have a history of atherosclerotic vascular disease, diabetes mellitus, or hypertension with associated cardiovascular risk factors	Angiotensin II receptor blockers	Class of recommendation IIa Level of evidence C
Hunt61,62 AHA/ACC Guideline (2005 and 2009)	Angiotensin II receptor blockers can be beneficial in patients with low EF and no symptoms of HF who are intolerant of ACEIs.	Stage B*	Angiotensin II receptor blockers	Class of recommendation IIa Level of evidence C
Hunt61,62 AHA/ACC Guideline (2005 and 2009)	Placement of an ICD might be considered in patients without HF	Stage B* who have non-ischemic cardiomyopathy and an LVEF ≤30% who are in NYHA I with chronic optimal medical therapy and have a reasonable expectation of survival with good functional status for >1 year.	ICD	Class of recommendation IIb Level of evidence C
Dickstein63 2008	Recommendation to treat with angiotensin receptor blockers (ARB) based upon the patients enrolled in the RCTs	LVEF ≤40% and either as an alternative in patients with mild to severe symptoms (NYHA II–IV) who are intolerant of an ACE-I or in patients with persistent symptoms (NYHA II–IV) despite treatment with an ACE-Inhibitor and beta-blocker	Candesartan Valsartan	Treatment reduces the risk of death from cardiovascular causes Class of recommendation I Level of evidence A 1. An ARB is recommended as an alternative in patients intolerant of an ACEI Class of recommendation IIa Level of evidence B 2. in patients with persistent symptoms (NYHA II–IV) despite treatment with an ACE-Inhibitor and beta-blocker Class of recommendation I Level of evidence B	Cohn 2001 CHARM-Added trial 2003 CHARM-Alternative trial 2003 Pfeffer 2003 OPTIMAAL trial 2002 McMurray 2004
Dickstein68 2010	Recommendation cardiac resynchronization therapy with defibrillator function in patients with heart failure in NYHA I/II	NYHA function class II LVEF ≤35%, QRS ≥150 ms, SR Optimal medical therapy	CRT preferentially by CRT-D is recommended to reduce morbidity or to prevent disease progression***	Class of recommendation I Level of evidence A	Abraham 2004 Moss 2009 Linde 2009 Daubert 2009