Revista Biomédica Revisada Por Pares
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Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) constitute first line treatment for patients with heart failure with reduced ejection fraction. However, their role in patients with preserved ejection fraction remains controversial. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews including five randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded ACEI and ARB do not decrease mortality or hospitalization risk in this group of patients.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers slow progression of disease and mortality in patients with heart failure and low ejection fraction. The effect on cardiac remodeling is considered the main mechanism of action, and it is also present in patients with preserved ejection fraction, so this benefit might extend to this group too.
We used Epistemonikos database, which is maintained by screening more than 30 databases, to identify systematic reviews and their included primary studies.
With this information we generated a structured summary using a pre-established format, which includes key messages, a summary of the body of evidence (presented as an evidence matrix in Epistemonikos), meta-analysis of the total of studies, a summary of findings table following the GRADE approach and a table of other considerations for decision-making.
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Key Messages
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What is the evidence. See evidence matrix in Epistemonikos later |
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What types of patients were included |
All studies considered heart failure of any etiology. Ejection fraction was >40% in three studies [6],[15],[16] and > 45% in two [9],[14]. |
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What types of interventions were included |
All studies compared against placebo or standard treatment, which generally included diuretics. |
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What types of outcomes were measured |
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The information on the effects of ACEI or ARB is based on five randomized trials [6],[9],[14],[15],[16] including 8226 patients. All studies reported total mortality and only three reported hospitalization by any cause [9],[15],[16].
Renin-angiotensin system blockade in heart failure with preserved ejection fraction
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To whom this evidence does and does not apply |
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| About the outcomes included in this summary |
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| Balance between benefits and risks, and certainty of the evidence |
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| Resource considerations |
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Differences between this summary and other sources |
| Could this evidence change in the future? |
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Using automated and collaborative means, we compiled all the relevant evidence for the question of interest and we present it as a matrix of evidence.
Follow the link to access the interactive version Renin-angiotensin system blockade in heart failure with preserved ejection fraction
The upper portion of the matrix of evidence will display a warning of “new evidence” if new systematic reviews are published after the publication of this summary.
Even though the project considers the periodical update of these summaries, users are invited to comment in the website of Medwave or to contact the authors through email if they realize there is new evidence and the summary should be updated earlier.
After creating an account in Epistemonikos, users will be able to save the matrixes and to receive automated notifications any time new evidence potentially relevant for the question appears.
The details about the methods used to produce this summaries are described here http://dx.doi.org/10.5867/medwave.2014.06.5997.
Epistemonikos foundation is a non-for-profit organisation aiming to bring information closer to those making health decisions, through the use of technology. Its main development is Epistemonikos database (www.epistemonikos.org).
These summaries follow a rigorous process of internal peer review.
Matrix of evidence
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Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) constitute first line treatment for patients with heart failure with reduced ejection fraction. However, their role in patients with preserved ejection fraction remains controversial. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews including five randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded ACEI and ARB do not decrease mortality or hospitalization risk in this group of patients.
Autores:
Carmen Rain[1], Gabriel Rada[1,2,3,4,5]
Citación: Rain C, Rada G. Are angiotensin-converting enzyme inhibitors or angiotensin 2 receptor antagonists effective in heart failure with preserved ejection fraction? . Medwave 2015 Mar;15(2):e6101 doi: 10.5867/medwave.2015.02.6101
Fecha de publicación: 19/3/2015
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Agarwal V, Briasoulis A, Messerli FH. Effects of renin-angiotensin system blockade on mortality and hospitalization in heart failure with preserved ejection fraction. Heart Fail Rev. 2013 Jul;18(4):429-37.
| CrossRef | PubMed |Balraj SH, Vijaya MM, Ken B, Rod ST, James MW. Angiotensin receptor blockers for heart failure. Cochrane Database of Systematic Reviews. 2012;4(4):CD003040. | CrossRef |Fu M, Zhou J, Sun A, Zhang S, Zhang C, Zou Y, Fu M, Ge J. Efficacy of ACE inhibitors in chronic heart failure with preserved ejection fraction--a meta analysis of 7 prospective clinical studies. Int J Cardiol. 2012 Feb 23;155(1):33-8. | CrossRef | PubMed |Meune C, Wahbi K, Duboc D, Weber S. Meta-analysis of Renin-Angiotensin-aldosterone blockade for heart failure in presence of preserved left ventricular function. J Cardiovasc Pharmacol Ther. 2011 Sep-Dec;16(3-4):368-75. | CrossRef | PubMed |Shah RV, Desai AS, Givertz MM. The effect of renin-angiotensin system inhibitors on mortality and heart failure hospitalization in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis. J Card Fail. 2010 Mar;16(3):260-7. | CrossRef | PubMed |Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006 Oct;27(19):2338-45. | CrossRef | PubMed |Dauterman KW, Go AS, Rowell R, Gebretsadik T, Gettner S, Massie BM. Congestive heart failure with preserved systolic function in a statewide sample of community hospitals. J Card Fail. 2001 Sep;7(3):221-8.
| CrossRef | PubMed |Grigorian Shamagian L, Roman AV, Ramos PM, Veloso PR, Bandin Dieguez MA, Gonzalez-Juanatey JR. Angiotensin-converting enzyme inhibitors prescription is associated with longer survival among patients hospitalized for congestive heart failure who have preserved systolic function: a long-term follow-up study. J Card Fail. 2006 Mar;12(2):128-33. | CrossRef | PubMed |Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008 Dec 4;359(23):2456-67. | CrossRef | PubMed |Philbin EF, Rocco TA Jr. Use of angiotensin-converting enzyme inhibitors in heart failure with preserved left ventricular systolic function. Am Heart J. 1997 Aug;134(2 Pt 1):188-95. | CrossRef | PubMed |Philbin EF, Rocco TA Jr, Lindenmuth NW, Ulrich K, Jenkins PL. Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors. Am J Med. 2000 Dec 1;109(8):605-13. | CrossRef | PubMed |Sueta CA, Russo A, Schenck A, Brown DW, Simpson RJ. Effect of angiotensin-converting inhibitor or angiotensin receptor blocker on one-year survival in patients >or=65 years hospitalized with a left ventricular ejection fraction >or=50%. Am J Cardiol. 2003 Feb 1;91(3):363-5. | CrossRef | PubMed |Tribouilloy C, Rusinaru D, Leborgne L, Peltier M, Massy Z, Slama M. Prognostic impact of angiotensin-converting enzyme inhibitor therapy in diastolic heart failure. Am J Cardiol. 2008 Mar 1;101(5):639-44. | CrossRef | PubMed |Yip GW, Wang M, Wang T, Chan S, Fung JW, Yeung L, et al. The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction. Heart. 2008 May;94(5):573-80. | CrossRef | PubMed |Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003 Sep 6;362(9386):777-81. | CrossRef | PubMed |Zi M, Carmichael N, Lye M. The effect of quinapril on functional status of elderly patients with diastolic heart failure. Cardiovasc Drugs Ther. 2003 Mar;17(2):133-9. | CrossRef | PubMed |Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):1810-52. | CrossRef | PubMed |Arnold JM1, Liu P, Demers C, Dorian P, Giannetti N, Haddad H, et al. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol. 2006 Jan;22(1):23-45. | CrossRef | PubMed |McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012 Jul;33(14):1787-847. | CrossRef | PubMed |
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