Translation of clinical trial results into practice.

Abstract

Angiotensin-converting enzyme (ACE) inhibitors have been shown in several large studies to prolong life and prevent disease progression in patients with heart failure and to prevent progression of left ventricular dysfunction following myocardial infarction. Despite this, it appears that a significant proportion of eligible patients are not receiving these agents and not obtaining their benefits. Patients in clinical trials are generally more selected and homogeneous than heart failure patients in the community. Clinicians may often feel that the typical clinical trial patient is not representative of many patients in their own practices and that trial results are often not generalizable to practice. It is only with the emergence of evidence from trials which more closely represent community practice and the promotion of agreed management guidelines that ACE inhibitors will be used more widely. Specialists and primary care practitioners need to provide an integrated approach to heart failure management to achieve optimal outcomes for patients.