Contemporary management of patients with left ventricular systolic dysfunction - Results from the Study of Patients Intolerant of Converting Enzyme Inhibitors (SPICE) Registry

Aims The reported prevalence of angiotensin-converting enzyme (ACE) inhibit or use in patients with heart failure varies considerably. Recent reports s uggest that many patients who could benefit from such therapy are not recei ving ACE inhibitors. The Study of Patients Intolerant of Converting Enzyme Inhibitors (SPICE) Registry was established to understand better the demogr aphics, characteristics, and contemporary use of ACE inhibitors in an inter national registry. Methods and Results Between August 1996 and April 1997, each of 105 study c entres from eight countries in North America and Europe was invited to revi ew retrospectively the medical records of 100 consecutive patients with lef t ventricular ejection fractions less than or equal to 35%. The median age of the 9580 Registry patients was 66 years, 26% were women, the median ejec tion fraction was 27%, and the primary aetiology of left ventricular dysfun ction was ischaemic (63%). Eighty percent of patients were receiving ACE in hibitors. The most common reason for non-use of ACE inhibitors was intolera nce (9%). Conclusion The SPICE Registry provides a contemporary description of the de mographics and management of patients with documented left ventricular syst olic dysfunction. The contemporary use of ACE inhibitors (80%) appears to b e higher than previously reported and the main reason for non-use is percei ved intolerance (9%).