SOLVD Trial - ACE inhibitors for NYHA II and III symptomatic heart failure.

BRIEF SUMMARY:

Here is the brief summary:

Name: SOLVD (yes the second SOLVD trial)

Specialty: Cardiology, Congestive Heart Failure. 

Problem: Heart failure (Symptomatic - unlike CONSENSUS which involved only NYHA class IV symptomatic patients and other SOLVD trial which involved asymptomatic patients (1992) this one involved NYHA class II and III patients)

HERE IS THE LINK FOR OTHER SOLVD TRIAL WHICH LOOKED ONLY AT ASYMPTOMATIC PATIENTS.

Population: 2568 patients (1256 and 1257 took Enalapril and Placebo)


Inclusion criteria:
Patients with congestive heart failure and ejection fractions of < 35% (0.35 or less) with mainly NYHA class II and III symptoms who were already taking drugs other than an angiotensin-converting—enzyme inhibitor as part of conventional therapy for congestive heart failure were eligible for the study. 
At that time only therapy most of these people were on was a diuretic and digoxin.(so only 1/4th on B-Blockers)
  Exclusion criteria:
Above 80 years of age.
Valvular heart disease
Unstable angina
Pulmonary disease
Elevated creatinine > 2.0
Other co-morbid disease like cancer

Intervention: Enalapril
Control: Placebo
Follow-up: Mean 41.4 months

Primary endpoint:
Mortality
Combined end point of death or hospitalizations
Secondary endpoint(s):
None
Details:

Enalapril vs placebo (in addition to diuretics, beta-blockers, nitrates & digoxin for specific indications only)


Brief Results:
Reduction of death in Enalapril group = 16% reduction in death.
Largest reduction of mortality in patient group with progressive heart failure = 22% reduction.
No effect on deaths due to arrhythmias
Overall reduction in hospitalizations.

Original Paper

Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure.

1 Aug 1991 N Engl J Med 1991; 325:293-302

CLICK HERE FOR ORIGINAL ARTICLE 

Here is the graph: