QUALITY-OF-LIFE IN OLDER PATIENTS WITH CONGESTIVE-HEART-FAILURE - EFFECTS OF ACE-INHIBITORS

Prolonged angiotensin converting enzyme (ACE) inhibition has been cons istently demonstrated to increase life expectancy in symptomatic patie nts with congestive heart failure (CHF), and decrease morbidity in asy mptomatic patients with left ventricular (LV) systolic dysfunction. Ho wever, prolonged ACE inhibition has not been shown to consistently imp rove the quality of life of patients with symptomatic CHF. The failure of ACE inhibition to improve quality of life cannot be readily explai ned, but several factors may contribute to this apparent lack of effec t. First, endpoints such as death or hospitalisation are clearly easie r to quantify and monitor than a patient's perception of how much CHF affects his/her life. Secondly, while ACE inhibition delays the progre ssion of LV systolic dysfunction, which is the primary determinant of prognosis, it may not reverse the alterations in skeletal muscle vascu lature, metabolism and mass, which are primarily responsible for exerc ise intolerance in patients with CHF Lastly, patients with CHF, and pa rticularly older patients, are also often incapacitated by other disea se processes such as arthritis, loss of balance, pulmonary disorders a nd anaemia, which, to a large extent, affect the quality of their life more than LV systolic dysfunction and/or CHF