Slide 14: In all cases In selected cases
Slide 20: 32 trials (3870 ACE inhibitors & 3235 placebo)
The reductions in mortality from CHF were greater for men than for women, for age < 60 years than for age > 60 years, for NYHA class IV, for ejection fraction <0.25, and for CHF caused by ischemic heart disease.
The greatest effect was seen during the first 3 months of treatment.
The groups did not differ for reductions in sudden death or fatal MI
Slide 23: 123 articles 18 trials 2986 patients
7 (n = 562) of metoprolol, 2 (n = 1509) of carvedilol, 2 (n = 36) of nebivolol, 1 (n= 641) of bisoprolol, 1 (n = 17) of acebutolol & 1 (n = 12) of labetalol
Improved LVEF (P < 0.001) (11 trials)
Higher rates of bradycardia, hypotension, and dizziness (P < 0.001) (13 trials)
A decreased rate of worsening of heart failure (P < 0.001) (13 trials)
no difference between β-blockers placebo for maximum exercise duration (9 trials)
Slide 26: No difference in deaths 1181 vs 1194
More patients in the digoxin group were hospitalized for digoxin toxicity than in
the placebo group (P < 0.001)
Subgroup analyses suggested a greater benefit among patients at high risk
Digoxin did not affect mortality but reduced hospitalizations in patients with heart
failure and normal sinus rhythm.
May need to be cautious in female where overdosing may occur
Slide 29: Main results
greater improvement in NYHA class (P < 0.001)
did not differ for adverse effects: 82% of patients in the spironolactone group had ≥ 1 event
compared with 79% of patients in the placebo group (P = 0.17)
“serious hyperkalemia” 1% vs 2% (ns); no comment on mild-moderate
men in tx group had higher rate of gynecomastia or breast pain (10% vs 1%, P < 0.001).
Spironolactone reduced all-cause mortality, death, and hospitalization from cardiac causes and
death from CHF and improved NYHA functional class in patients with severe CHF.
Heart Failure & Sudden Cardiac Arrest : Heart Failure & Sudden Cardiac Arrest Framingham Heart study – Heart Failure predicts SCD and overall mortality Reduced Left Ventricular Ejection Fraction & risk for sudden cardiac arrest
Sudden cardiac Death : Sudden cardiac Death SCD-HeFT Trial Implantable Defibrillator ICD significantly reduced mortality at 4 year follow up