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Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status

A meta-analysis of major clinical trials

Paul G. Shekelle, MD, PhD^*,*, Michael W. Rich, MD, Sally C. Morton, PhD^*, Col. Sid W. Atkinson, MD^||, Wenli Tu, MS^*, Margaret Maglione, MPP^*, Shannon Rhodes, MFA^*, Michael Barrett, MD^¶, Gregg C. Fonarow, MD^#**, Barry Greenberg, MD, Paul A. Heidenreich, MD, MS, Tom Knabel, MD^||||, Marvin A. Konstam, MD^¶¶, Anthony Steimle, MD^## and Lynne Warner Stevenson, MD^***

^* Southern California Evidence-Based Practice Center, RAND Health, Santa Monica, California, USA
Division of General Internal Medicine, Greater Los Angeles VA Medical Center, Los Angeles, California, USA
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
RAND Arroyo Center, Santa Monica, California, USA
^|| Southeast Regional Medical Command, U.S. Army Medical Department, Athens, Georgia, USA
^¶ Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
^# Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California, USA
^** Division of Cardiology, University of California at Los Angeles, Los Angeles, California, USA
Heart Failure/Cardiac Transplantation Program, University of California, San Diego, California, USA
Department of Medicine, Stanford University, Stanford, California, USA
VA Palo Alto Healthcare System, Stanford, California, USA
^|||| Ingenix, Eden Prairie, Minnesota, USA
^¶¶ Department of Medicine, Division of Cardiology, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
^## Heart Failure Program, Kaiser Permanente Northern California, Santa Clara, California, USA
^*** Cardiomyopathy and Heart Failure Program, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA

View larger version (16K): [in a new window]   Figure 1 Effect of angiotensin-converting enzyme inhibitors on mortality in patients with heart failure. For each study, the size of the box is proportional to the sample size, and the lines denote the 95% confidence interval. For the combined result, the ends of the diamond shape denote the 95% confidence interval. Trial acronyms defined in the Abbreviation Box. Prev = prevention; Tx = treatment.

View larger version (21K): [in a new window]   Figure 2 Effect of angiotensin-converting enzyme inhibitors on mortality in male and female patients with heart failure (random effects pooled estimate). For each study, the size of the box is proportional to the sample size, and the lines denote the 95% confidence interval. For the combined result, the ends of the diamond shape denote the 95% confidence interval. Trial acronyms defined in Abbreviation Box.

View larger version (14K): [in a new window]   Figure 3 Effect of beta-blockers on mortality in patients with heart failure. For each study, the size of the box is proportional to the sample size, and the lines denote the 95% confidence interval. For the combined result, the ends of the diamond shape denote the 95% confidence interval. Trial acronyms defined in Abbreviation Box.