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CONSENSUS vs SOLVD ACEi Evidence — EECC MCQ

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ModerateHeart FailureCONSENSUS vs SOLVD ACEi EvidenceEECC

A 55-year-old man with HFrEF asks about the difference between the CONSENSUS and SOLVD-Treatment trials. Both studied enalapril in HFrEF. What was the key difference?

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Correct answer: C — CONSENSUS enrolled severe HFrEF (NYHA IV) and showed 40% mortality reduction at 6 months; SOLVD-Treatment enrolled milder HFrEF (NYHA II-III) and showed 16% mortality reduction at 4 years — together they established ACEi as foundational therapy across the HFrEF spectrum

The ACEi evidence in HFrEF was established by two landmark trials: (1) CONSENSUS (1987): enrolled 253 patients with severe HFrEF (NYHA IV, median LVEF ~25%); enalapril vs placebo; terminated early for 40% 6-month mortality reduction (27% vs 44%) and 31% 12-month reduction. This was the first drug to reduce mortality in HF; (2) SOLVD-Treatment (1991): enrolled 2,569 patients with milder HFrEF (NYHA II-III, LVEF ≤35%); enalapril vs placebo for mean 3.5 years; 16% mortality reduction (35% vs 40%). Together: these trials established ACEi as foundational therapy across the severity spectrum. The SOLVD-Prevention trial (asymptomatic LV dysfunction) showed reduced HF hospitalisation but not mortality. These remain among the most important trials in cardiovascular medicine, forming the basis for the Class I ACEi recommendation that has persisted for >35 years.

Reference: ESC (2023): HF Guidelines; CONSENSUS/SOLVD Trials