If the extracted study populace had a 10% deviation from your reference study, it was termed as a close match; if the deviation was 11C20%, it was termed a fair match; and if the deviation was 20%, it was termed a poor match These parameters were set out = 72), (%) /th /thead Mean age, years (SD)69 (9)Female14 (19)Male58 (81)Ever smoked50 (69)Non-white2 (3) Any electrocardiogram abnormality2 (3)Mean height, metres (SD)1.71 (0.09)Mean weight, kg (SD)80.8 (14.6)Mean heart rate, beats per min (SD)77.3 (17.8)Mean forced expiratory GSK189254A volume at 1 second, litres (SD)2.11 (0.76)Mean forced vital capacity, litres (SD)2.55 (0.85)Mean systolic blood pressure, mmHg (SD)148.4 (21.1)Mean diastolic blood pressure, mmHg (SD)87.1 (12.3) New York Heart Association class I34 (47)II26 (36)III5 (7)IV7 (10) History Myocardial ischaemia38 (53)Angina26 (36)Hypertension28 (39)Diabetes11 (15)Family myocardial ischaemia (age 65 years)25 (35) Medication taken ACE inhibitors19 (26)Diuretics26 (36)Beta-blockers9 (13)Calcium antagonists15 (21)Aspirin38 (53)Digoxin 5 (7) Open in a separate window SD = standard deviation. NYHA class Table 4 shows heart failure RCTs compared to the reference population, stratified by NYHA class. were representative of the reference populace. Conclusion Patients recruited to studies typically had more severe heart failure than the reference primary care populace. When evidence from sicker patients is usually generalised to less sick people, there is increased uncertainty about benefit and also a risk of harm from overtreatment. More evidence is needed on the effectiveness of treatment of heart failure in asymptomatic patients with NYHA class I. How this fits in Heart failure is usually common in main care and carries a high morbidity and mortality which is usually associated with the degree of failure; beta-blockers, ACE inhibitors or angiotensin II receptor blockers (ARBs), and aldosterone antagonists have all been shown to reduce mortality and morbidity, but also carry a significant risk of adverse drug reactions. This study shows that patients with heart failure in primary care tend to have moderate heart failure, but the evidence for effectiveness for these drugs comes from a populace with more severe heart failure. More evidence is needed for the effectiveness of these treatments in populations common of primary care. Introduction HFrEF is usually a common chronic, debilitating disease which has a prevalence of 0.7% and affects 400?000 adults in the UK.1 The annual cost of heart failure to the NHS is around 2% of its total budget, and approximately 70% of this total is due to the costs of hospitalisation.2 There is a large variance in clinical presentation of heart failure, with some patients having no symptoms at the time of diagnosis whereas others have significant morbidity. The diagnosis is made based on the presence of signs and symptoms of heart failure and through the use of echocardiography to measure left ventricular ejection portion (LVEF).3 An LVEF 40% confirms a diagnosis of HFrEF, which has been extensively studied in the literature. Symptoms of heart failure can be graded using the NYHA functional classification into one of four groups (Box 1).4 In one study of UK primary care patients with HFrEF, 47% experienced no symptoms (class I), 36% experienced mild symptoms (class II), 7% experienced moderate symptoms (class III), and 10% experienced severe symptoms (class IV).5 Mortality rates from heart failure are high; one UK cohort study reported that 14% (95% confidence interval [CI] = 11% to 18%) of patients died within 6 months of diagnosis.6 Patients with higher NYHA symptom scores have a worse prognosis, although even patients with mild heart failure have higher mortality than the general populace.7 Several large Rabbit polyclonal to AP3 trials have found a reduction in mortality and hospitalisation in patients with systolic heart failure following treatment with beta-blockers, ACE inhibitors, and aldosterone antagonists.8,9 These drugs have also GSK189254A been shown to be cost-effective for the treatment of heart failure.10 This evidence has led to guideline recommendations adopting these treatments for systolic heart failure across the world.2,7,11,12 The National Institute for Health and Care Excellence (Good) heart failure guideline recommends that all primary care patients with systolic heart failure should be offered beta-blockers and ACE inhibitors, regardless of NYHA class. This indicator is usually supported by evidence generalised from higher risk populations (NYHA classes IIICIV), GSK189254A in which there is obvious evidence of benefit for beta-blockers and ACE inhibitors, but the evidence of benefit in lower risk populations is usually more equivocal.13,14 The applicability of guideline recommendations for management of diseases (including heart failure) in primary care has recently been questioned as this research is rarely conducted in representative populations.13 This question is usually important in heart failure because the effectiveness of treatment may depend on the severity of disease, and beta-blockers and ACE inhibitors carry significant morbidity risk, accounting for approximately one in seven emergency hospital admissions due to adverse drug reactions.15 The aim of this study was to determine to what extent patients included in studies of heart failure treatment with beta-blockers, ACE inhibitors, and aldosterone antagonists were representative of the NYHA class and other characteristics of a typical primary care population with heart failure in England. Method A GSK189254A literature search was undertaken to identify RCTs of systolic heart failure drugs. MEDLINE, MEDLINE In-Process, EMBASE, and CENTRAL were searched from inception to March 2015. The search strategy for MEDLINE (further information available from your authors on.