Seven studies (2,554 participants, range 74 to 850) were included. Date of publication ranged from 1997 to 2008. Two studies scored 2 for quality and one each scored 3, 4, 5, 6 and 7. Tests showed no evidence of publication bias.
Compared to controls, ACE inhibitors were associated with a statistically significant reduction in all-cause mortality (OR 0.52, 95% CI 0.41 to 0.64; Ι²=18%; seven studies). Removal of one study resulted in a similar effect. Stratification according to length of follow-up showed similar results for all periods.
There was no statistically significant difference in death from worsening heart failure (Ι²=0%; three studies), heart failure related hospitalisation (Ι²=17%; four studies) and all-cause hospitalisation (Ι²=0%; three studies).
Subgroup analysis showed a beneficial effect on all-cause mortality for those less than 75 years old and at different follow-up times (>20.9 months and <20.9 months) and for heart failure-related hospitalisation in those more than 75 years old and at more than 20.9 months follow-up but not for other subgroups. Sensitivity analyses indicated no effect of study quality.
There was insufficient data available to meta-analyse results for quality of life and six-minute walk distance.