How to use Clinical Evidence
to inform clinical decision
making
A case study using the CE
review on heart failure
Your case:
You are a junior doctor in a hospital. A 55year-old man with a heart condition has
come into your hospital for a consultation.
The man has already been prescribed an
ACE inhibitor but this is not controlling his
heart condition. You discuss the case with
your advisor, who suggests that you
prescribe an angiotensin II receptor blocker
in addition to the ACE inhibitor.
You are a little unsure of this, as you have
not heard of combining these two drugs
before... and you would like to make sure
that this is the correct decision...
Summary
• Check the severity of your patient’s heart
condition
• The evidence for reduced mortality with
combining ACE inhibitors with angiotensin II
receptor blocker in NYHA functional class II–
IV heart failure is not certain; however, there
is high-quality evidence that the combination
reduces hospital admissions compared with
ACE inhibitor alone
• Consider adding angiotensin II receptor
blocker to the patient’s ACE inhibitor