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Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Slide: 9 of 21

Patient Discussion: Potential Benefits of ACEIs

You explain that current research shows there is good evidence that adding an ACEI to his usual care may offer him:

Discussion of answers:

A. Incorrect. ACEIs reduce the risk of mortality, nonfatal myocardial infarction, as well as heart failure-related hospitalizations.

B. Incorrect. ACEIs reduce the risk of mortality, nonfatal myocardial infarction, as well as heart failure-related hospitalizations.

C. Incorrect. ACEIs reduce the risk of mortality, nonfatal myocardial infarction, as well as heart failure-related hospitalizations.

D. Correct. According to the CER titled, Comparative Effectiveness of Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease, there is high level evidence that the addition of ACEI to standard therapy for these patients reduces risk of mortality (absolute risk reduction (ARR) = 1.1, 13% relative risk reduction (RRR), and number needed to treat (NNT) = 91), nonfatal myocardial infarction (ARR = 1.1, 17% RRR, and NNT = 91), and heart failure-related hospitalizations (ARR = 0.6, 22% RRR, and NNT = 167).  Additionally, adding an ACEI to the standard therapy of a stable ischemic heart disease patient with preserved left ventricular systolic function reduces their relative risk of having future revascularizations by 10% (ARR = 1.3 and NNT = 77).