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SOLVD (Studies of Left Ventricular Dysfunction)
Enalapril vs placebo in 6,794 patients
Ejection fraction < 35%
End points include:
Delaying the progression of heart failure
Improving signs and symptoms
Reducing mortality
Treatment arm - 2,568 symptomatic class II-III patients most on digitalis and diuretics
Prevention arm - 4,226 asymptomatic class I-II patients, most on no concomitant therapy
N Engl J Med 1991:325:293-302
SOLVD Treatment Trial All Cause Mortality
N Engl J Med 1991;325:293-302
16% Risk Reduction
p = 0.0036
Benefits of Enalapril
Patients:  Symptomatic HF patients with LVD (EF < 35%)
Increased Survival
32% at 3 months
28% at 6 months
21% at 12 months
18% at 24 months
12% at 36 months
12% at 48 months
11% reduction of overall mortality at end of study (P=0.0036)
The SOLVD Investigators, N Engl J Med. 1991;325:293
SOLVD Treatment Trial Mortality or Hospitalization for CHF
N Engl J Med 1991;325:293-302
26% Risk Reduction
p<0.0001
SOLVD Treatment-Enalapril
Symptomatic HF Patients with LVD (EF < 35%)
(NYHA Class II-III)
Number of Hospitalizations Due to Heart failure
The SOLVD Investigators, N Engl J Med, 1991
971
683
30% Reduction
p<0.001
SOLVD Treatment-Enalapril
Symptomatic HF Patients with LVD (EF < 35%)
(NYHA Class II-III)
Number of Readmissions for Heart failure
The SOLVD Investigators, N Engl J Med, 1991
234
157
33% Reduction
p<0.001
SOLVD Treatment Trial
Implications:
Treating 1,000 patients for 3 years
Prevents about 50 deaths
Prevents about 350 hospitalizations
Benefits of Enalapril
Patients:  Symptomatic HF patients with LVD (EF < 35%)
Decreased hospitalizations
48% at 3 months
51% at 6 months
46% at 12 months
23% at 24 months
28% at 36 months
30% reduction of overall hospitalization at end of study  (P<0.0001)
Convenient once - or twice - daily dosing
The SOLVD Investigators, N Engl J Med. 1991;325:293
SOLVD Treatment Trial Conclusions
Hospitalizations:
Risk reduced by 20% (p<0.001)
Significant reduction in CHF hospitalization by 1/3 (p<0.0001)
Sustained benefit over 4 years
N Engl J Med 1991;325:293-302
SOLVD Prevention Trial All Cause Mortality
Risk Reduction 8%
P=0.30
N Engl J Med 1992;327:685-91
SOLVD Prevention Trial Death or Development of CHF
Risk Reduction 29%
p<0.001
N Engl J Med 1992;327:685-91
SOLVD Prevention Trial First Hospitalization for CHF
Risk Reduction 36%
p<0.001
N Engl J Med 1992;327:685-91
SOLVD Prevention Trial
N Engl J Med 1992;327:685-91
SOLVD Prevention- Enalapril Asymptomatic HF Patients w/ LVD (EF < 35%)
(NYHA Class I-II)
32% Fewer First
Hospitalizations
p<0.001
Number of First Hospitalizations for Heart Failure
The SOLVD Investigators, N Engl J Med, 1992.
273
184
SOLVD Prevention Trial Morbidity and Combined Outcomes
Enalapril - Dosing