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Am Fam Physician. 2003;68(7):1420-1421

It is well established that the use of angio-tensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs) improve survival in patients with systolic dysfunction. However, the role of these agents in treating persons with heart failure and diastolic dysfunction is less clear. To study the effects of posthospitalization use of ACE inhibitors or ARB agents on survival rates after discharge, Sueta and associates conducted a retrospective case review of patients who were at least 65 years of age and hospitalized for heart failure.

Diastolic dysfunction was defined as preserved left ventricular function with ventricular ejection fraction of 50 percent or greater or the presence of qualitatively normal ventricular contractions assessed using echocardiography, radionuclide ventriculography, or contrast ventriculography. The demographics and comorbidities of the patients who were discharged while receiving an ACE inhibitor or ARB agent were similar to those who did not receive these medications. Although more of the treated group had diabetes or a history of hypertension, renal function was significantly worse in patients who were not receiving one of the medications.

Within one year of discharge, 27 percent of the patients with diastolic dysfunction had died. Eighty-six patients (22 percent) in the group discharged on an ACE inhibitor or ARB died, compared with 122 patients (34 percent) who were not receiving these agents at discharge. Patients who were discharged on one of these agents were 68 percent more likely to be alive one year after hospitalization.

The authors conclude that discharge of older patients with normal ventricular function following hospitalization for heart failure with ACE inhibitors or ARB agents is an independent predictor of increased one-year survival. This is consistent with other studies that found that blocking the renin-angiotensin system improves New York Heart Association class and exercise tolerance in patients with heart failure secondary to diastolic dysfunction.

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