QUALITY-OF-LIFE AMONG 5,025 PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION RANDOMIZED BETWEEN PLACEBO AND ENALAPRIL - THE STUDIES OF LEFT-VENTRICULAR DYSFUNCTION

Objectives. This study was performed to assess the quality of life of patients with left ventricular dysfunction for up to 2 years after ran domization to enalapril or placebo. Background. Previous reports have documented that survival of patients with congestive heart failure can be extended by the angiotensin-converting enzyme inhibitor enalapril. However, it is unknown whether enalapril has a long-term favorable im pact on the quality of life in patients with heart failure. Methods. A brief quality of life questionnaire assessing the quality of life was administered at baseline and at 6 weeks, 1 year and 2 years of follow -up to patients randomized to placebo or enalapril in the Studies of L eft Ventricular Dysfunction (SOLVD). Participants had an ejection frac tion less than or equal to 0.35, no other serious illnesses and either symptomatic heart failure (treatment trial, n = 2,465) or asymptomati c left ventricular dysfunction (prevention trial, n = 2,560). Results. Among the 14 scales of quality of life, better scores at one or more follow-up intervals were noted in 6 scales in the treatment trial and in 1 scale in the prevention trial among patients assigned to enalapri l. Consistent superiority with enalapril at two consecutive follow-up intervals was noted in the treatment trial for social functioning and dyspnea but for no scale in the prevention trial. However, an average of 40% of quality of life responses were missing at 2 years of follow- up because of death or failure to complete the questionnaire. In the t reatment trial, survivors with more severe heart failure were less lik ely to complete the questionnaire. Conclusions. Modest benefits in qua lity of life for greater than or equal to 1 year occurred when patient s with left ventricular dysfunction and symptomatic heart failure were treated with enalapril. No apparent beneficial or adverse effect on q uality of life was observed with enalapril in asymptomatic patients wi th left ventricular dysfunction.