Efficacy of ACE inhibitors in chronic heart failure with preserved ejection fraction — A meta analysis of 7 prospective clinical studies

Abstract

BackgroundThe effect of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction remains controversial. AimsTo assess the impact of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction. Methods and resultsSeven prospective studies evaluating the effect of ACE inhibitors compared to placebo or other classes of drugs, such as monotherapy or first-line therapy, on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction were included. A total of 2554 patients (mean age: 75.1years, female: 58%) were recruited with an average follow up of 20.9months. The primary etiology of heart failure with preserved ejection fraction was ischemic heart disease (33.7%), hypertension (69.1%) and diabetes mellitus (25.8%). Our results demonstrated that ACE inhibitors significantly reduced all-cause mortality (odds ratio, OR=0.52; 95% Confidence Interval (CI), 0.41 to 0.64; P<0.01). Furthermore, ACE inhibitors were able to reduce heart failure related rehospitalization or treatment over 20.9months (p<0.05) in a subgroup of patients aged over 75years. However, death due to worsening of heart failure, heart failure related rehospitalization and any-cause readmission were not affected (OR=0.88; 95% CI: 0.66 to 1.17; P=0.37 for death due to worsening of heart failure; OR=0.81; 95% CI: 0.63 to 1.05; P=0.11 for heart failure related rehospitalization and OR=0.88; 95% CI: 0.68 to 1.14; P=0.33 for any-cause readmission, respectively). ConclusionsIn patients with chronic heart failure with preserved ejection fraction, ACE inhibitors reduced all-cause mortality without affecting mortality due to heart failure and any-cause rehospitalization.