A systematic review 1 including 20 studies (three individual patient data studies and one other long-term study (n=10,908 at follow-up) and 16 short-term studies of patients with chronic HF (3 months' follow-up; n=2,302)) was abstracted in DARE. In the large long-term studies, treatment with ACE inhibitors was associated with a significantly reduced risk of being in NYHA class II-IV compared with class I (OR 0.875, 95% CI: 0.811 to 0.943, P=0.0005). ACE inhibitors were associated with a significantly reduced risk of being in NYHA class II-IV compared with class I only in studies that included patients with chronic HF (OR 0.66, 95% CI: 0.52 to 0.84, P=0.001; based on two studies); the risk reduction was not significant in studies of patients with acute MI (based on two studies). In the short-term studies, patients treated with ACE inhibitors were significantly more likely to show an improvement of at least one NYHA class (random-effects OR 2.11, 95% CI: 1.48 to 2.98, P<0.0001; significant statistical heterogeneity was present).
Comment: The quality of evidence is downgraded by poor reporting of the methodology of the included studies.
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