ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN LEFT-VENTRICULAR DYSFUNCTION

Angiotensin-converting enzyme (ACE) inhibitors have been used for more than a decade in the treatment of chronic congestive heart failure, I n recent years these agents have been used in patients who survived a myocardial infarction. However, primary care providers are often confu sed as to which patients would benefit the most, and as a result, thes e life-prolonging drugs are underutilized. The results of randomized c ontrolled trials evaluating ACE inhibitors' effects on morbidity and m ortality in patients with chronic congestive heart failure or acute my ocardial infarction were evaluated, Angiotensin-converting enzyme inhi bitors clearly improve survival in patients with symptomatic congestiv e heart failure. This survival benefit is approximately 6 months. In p atients with asymptomatic systolic dysfunction, these agents also decr ease the number of hospital admissions due to heart failure. Angiotens in-converting enzyme inhibitors also improve survival in all patients who experienced an acute myocardial infarction. With the plethora of e vidence regarding the positive effects that this class of drugs has on the quality of life and survival of patients with systolic dysfunctio n, it is still unclear why clinicians are reluctant to use them more o ften. Primary care providers need to be educated on how to risk strati fy patients to make this therapy more cost effective, and when these a gents should be started.