Summary of findings 3. Angiotensin‐converting enzyme inhibitors (ACEIs) compared to placebo or no treatment for chronic heart failure with preserved ejection fraction.
| ACEIs compared to placebo or no treatment for chronic heart failure with preserved ejection fraction | ||||||
| Patient or population: patients with chronic heart failure with preserved ejection fraction Setting: secondary care Intervention: ACEIs Comparison: placebo or no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo/no treatment | Risk with ACEI | |||||
| Cardiovascular mortality (RR) follow‐up: range mean 12 months to mean 26.2 months | Study population | RR 0.93 (0.61 to 1.42) | 945 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | One additional trial (Kitzman 2010) reported that no deaths occurred | |
| 86 per 1000 | 81 per 1000 (53 to 123) | |||||
| Heart failure hospitalisation (RR) follow‐up: range 6 months to 26.2 months | Study population | RR 0.86 (0.64 to 1.15) | 1019 (3 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 13 per 1000 | 11 per 1000 (8 to 15) | |||||
| Hyperkalaemia follow‐up: 6 months |
74 (1 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 3 4 | One trial (Zi 2003) reported 2 events in the intervention group (N = 36), 0 events in the control group (N = 38) (RR 5.27, 95% CI 0.26 to 106.16) | |||
| All‐cause mortality (RR) follow‐up: range mean 6 months to mean 26.2 months | Study population | RR 1.04 (0.75 to 1.45) | 1187 (5 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | One additional trial (Kitzman 2010) reported that no deaths occurred | |
| 102 per 1000 | 106 per 1000 (77 to 148) | |||||
| Quality of life (MLHFQ): from 0 to 105 follow‐up: mean 12 months | Mean quality of life (MLHFQ) ranged from 10.9 to 29 | MD 0.09 lower (3.66 lower to 3.48 higher) | ‐ | 154 (2 RCTs) | ⊕⊕⊝⊝ LOW 2 3 | Scale: 0 to 105, lower = better, 5 point difference considered clinically relevant One trial (SNEGOVIK) reported mean change from baseline of ‐19.8 for intervention and ‐10.7 for control |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ACEIs: Angiotensin‐converting enzyme inhibitors; CI: Confidence interval; MD: Mean difference; MLHFQ: Minnesota Living with Heart Failure Questionnaire; RCT: Randomised controlled trial; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1Downgraded by one level due to imprecision (wide CI).
2Downgraded by one level due to study limitations (risk of bias (open label)).
3Downgraded by one level due to imprecision (low sample size).
4Downgraded by one level due to study limitations (unclear selection bias).