Quality of life in older patients with congestive heart failure. Effects of ACE inhibitors.
Prolonged angiotensin converting enzyme (ACE) inhibition has been consistently demonstrated to increase life expectancy in symptomatic patients with congestive heart failure (CHF), and decrease morbidity in asymptomatic patients with left ventricular (LV) systolic dysfunction. However, prolonged ACE inhibition has not been shown to consistently improve the quality of life of patients with symptomatic CHF. The failure of ACE inhibition to improve quality of life cannot be readily explained, but several factors may contribute to this apparent lack of effect. First, endpoints such as death or hospitalisation are clearly easier to quantify and monitor than a patient's perception of how much CHF affects his/her life. Secondly, while ACE inhibition delays the progression of LV systolic dysfunction, which is the primary determinant of prognosis, it may not reverse the alterations in skeletal muscle vasculature, metabolism and mass, which are primarily responsible for exercise intolerance in patients with CHF. Lastly, patients with CHF, and particularly older patients, are also often incapacitated by other disease processes such as arthritis, loss of balance, pulmonary disorders and anaemia, which, to a large extent, affect the quality of their life more than LV systolic dysfunction and/or CHF.
Fergus
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Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Demopoulos
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LeJemtel
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TH
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D011788:Quality of Life; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors