Letter Regarding Article by Masoudi et al, “National Patterns of Use and Effectiveness of Angiotensin-Converting Enzyme Inhibitors in Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction”

Abstract

To the Editor: We read with great interest the article by Masoudi et al,1 in which “a stubborn, persistent gap between ideal practice and actual use of ACE inhibitors for heart failure” was shown. The editorial by Mark Hlatky2 also stimulated our reflections. The gap between ideal and practical use in the cardiovascular field and other fields of medicine may have various explanations. Data have shown that the “real patient” is different from the “trial patient”; in fact the latter, even if old, is usually in good general condition, without comorbidities and cognitive and physical impairments. This patient may be considered a “robust” or an “intermediate” subject.3 In the real world, however, many patients are frail, with severe comorbidities, polypharmacy, cognitive or physical disabilities, and …