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Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

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Clinical Questions Addressed by the CER for Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

This CER focused on a population of patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function (LVSF). The clinical trials evaluated in this CER included ischemic heart disease patients without left ventricular systolic dysfunction, which was defined as having a left ventricular ejection fractions greater than 40%. The key questions centered around the comparative effectiveness of 1) adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to standard medical therapy versus standard medical therapy alone, 2) combining an ACEI with an ARB and adding them to standard medical therapy versus adding an ACEI alone to standard medical therapy, or 3) adding an ACEI or an ARB to standard medical therapy versus standard medical therapy alone in patients with stable IHD and preserved LVSF who are in close proximity to a revascularization procedure.

The comparative effectiveness of ACEIs versus ARBs was not a focus of the CER. 

This CER focused on a population of patients with stable IHD who also have preserved LVSF. The key questions centered around the comparative effectiveness of ACEIs or ARBs added to standard medical therapy versus standard medical therapy alone; or centered around the combined use of ACEIs and ARBs added to standard medical therapy versus an ACEI added to standard medical therapy. Among the clinical trials included in this general category, some were conducted where recent coronary revascularization procedures were a prerequisite for enrollment. These clinical trials were evaluated separately from those in which this was not a prerequisite.