The Effects of Enalapril on Mortality and the Development of Heart failure in Asymptomatic Patients with Reduced Left Ventricular Ejection Fractions - SOLVD-Prevention
Enalapril vs. placebo for hospitalization and mortality in heart failure.
Enalapril reduces mortality incidence of symptomatic heart failure, and rate of hospitalization for heart failure.
Patients Screened: 39,924
Patients Enrolled: 4,228
NYHA Class: I=(67%), II=(33%)
Mean Follow Up: 37 months (15 - 62)
Mean Patient Age: 59
Mean Ejection Fraction: 28%
Absence of substantive congestive heart failure symptoms
Receiving digitalis, diuretics or vasodilators
(Remainder same as SOLVD Treatment Trial)
Death or hospitalization for congestive heart failure
Development of congestive heart failure
Development of congestive heart failure and anti-CHF therapy
First hospitalization for CHF
Multiple hospitalizations for CHF
Death or development of CHF
Death or hospitalization for CHF
Enalapril (starting at 2.5 mg bid titrating up to 10 mg bid)
Beta blockers (24%)
Calcium channel blockers (35%)
Trend toward reduced mortality in Enalapril group versus placebo (RR 8% ; p = 0.3).
Significant reduction by Enalapril in combined endpoint of death/development of CHF (RR 29%; p < 0.001)
Fewer patients died or were hospitalized with congestive heart failure (RR 20%; p < 0.001)
Enalapril reduces risk of development of heart failure and hospitalization for heart failure in patients without substantive symptoms and EF < 35%. There was a trend toward fewer cardiovascular deaths in patients receiving Enalapril. This study indicates that ACE inhibitors are first line therapy in early heart failure manifested by left ventricular systolic dysfunction with no or minimal symptoms.
1. N Engl J Med 1992;327:685-69. Final results
2. Am J Cardiol 1995;75:1244-9. Ventricular arrhythmia substudy
3. Am J Cardiol 1996;78:890-5. Quality of life
Keywords: Enalapril, Heart Failure, Ventricular Dysfunction, Left
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