Benefits and adverse effects of ACE inhibitors in patients with heart failure with reduced ejection fraction: a systemat
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REVIEW
Benefits and adverse effects of ACE inhibitors in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis Sylvaine Bœuf-Gibot 1 & Bruno Pereira 2 & Jérémy Imbert 1 & Hanna Kerroum 1 & Thibault Menini 1,3 & Elodie Lafarge 3,4 & Manuela De Carvalho 5 & Philippe Vorilhon 1,3 & Rémy Boussageon 6,7 & Hélène Vaillant-Roussel 1,3 Received: 20 August 2020 / Accepted: 7 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Angiotensin-converting enzyme (ACE) inhibitors are part of first-line treatment for reduced ejection fraction heart failure (HFrEF). The aim was to assess the benefits and adverse effects of ACE inhibitors in HFrEF with a focus on important patient outcomes. Methods A systematic review of double-blind randomized clinical trials (RCTs) and comparison of ACE inhibitors versus placebo, in HFrEF patients published in French or English. Searches were undertaken of Medline, Cochrane Central, and Embase. The primary outcomes were all-cause mortality and adverse events. Results From 636 articles analysed, 11 were included (13,882 patients). For all-cause mortality (5 RCTs, 9277 patients), the number needed to treat (NNT) to avoid one death at 6 months was 50 (33–107). The NNT to prevent one death at 12 months (6 RCTs, 13,016 patients) was 63 (35–314). Under the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the evidence was of moderate quality. The number needed to harm was 12 (10–15) for cough, 20 (14–31) for hypotension, 23 (17–36) for dizziness, 31 (23–47) for hyperkalaemia, and 49 (30–121) for increased creatinine levels. The quality of evidence was moderate for these criteria except for cough (low quality of evidence). Conclusion This review focuses on clinical elements necessary in a shared decision-making process. In practice, general practitioners will be able to use these data to discuss ACE inhibitor treatment with HFrEF patients. This study was registered in the PROSPERO registry under the reference number CRD42018096930. Keywords Systolic heart failure . ACE inhibitors . Systematic review . Randomized controlled trials . Shared decision making . General practice
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-03018-4) contains supplementary material, which is available to authorized users. * Hélène Vaillant-Roussel [email protected] 1
Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France
2
Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
3
UPU ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France
4
Pharmacy Faculty, Clermont Auvergne University, Clermont-Ferrand, France
5
University Library, Clermont Auvergne University, Clermont-Ferrand, France
6
Collège Universitaire de Médecine Générale, UCBL, Lyon 1, France
7
UMR 5558, LBBE - EMET, CNRS – UCBL, Lyon 1, France
Eur J Clin Pharmacol
Introduction Systolic heart
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