Effect of Angiotensin Converting Enzyme Inhibitors on Functional Capacity in Elderly Patients with Heart Failure and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Abstract

Background The impact of angiotensin converting enzyme inhibitors (ACEI) on functional capacity and quality of life in elderly patients with heart failure and preserved ejection fraction (HFpEF) is not well understood. This systematic review sought to evaluate the efficacy of ACEI in elderly patients with HFpEF. Methods We performed electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through December 15, 2018 to identify randomized controlled trials that evaluated the efficacy of ACEI in elderly patients with HFpEF. The primary outcomes of our study were improvement in quality of life (QoL; as assessed by Minnesota Living with Heart Failure questionnaire) and 6-minute walk test. The results were expressed as a standard mean difference (SMD) for the continuous variables with 95% confidence intervals (CIs). A Mantel-Haenszel random effects model was used to summarize data across treatment arms. Heterogeneity between the studies was assessed using the chi square test and was considered significant for p values 50%. Results Four randomized trials with 1,090 patients (mean age 73.5 years) were included, in which 545 patients received ACEI. Weighted mean duration of follow-up was 10.4 months. There were no significant improvements observed in QoL measures (SMD: 0.26; 95% CI: -0.04 to 0.57, p=0.09) or 6-minute walk test performance (SMD: -0.08; 95% CI: -0.39 to 0.22, p=0.60) with ACEI use. Conclusion The use of ACEI in elderly patients with HFpEF was not associated with improvements in exercise tolerance or quality of life. There was non-significant trend to improvement of quality of life in patients who received placebo. Future studies are necessary to better define the role of ACEI in this patient subset.