We now have conclusive data that ACE inhibitors reduce mortality, morbidity, and symptoms in patients with low ejection fraction and/or heart failure. Therefore, ACE inhibitors should be routinely used in all such patients, as long as there are no clear contraindications. Routine use of ACE inhibitors will lead to prolongation of survival and a reduction in the number of hospitalizations for heart failure and ischaemic events. The reduction in costs associated with the prevention of these events is likely substantially to offset the cost of the use of these therapies. Therefore, ACE inhibitors should be instituted as early as possible in patients with LV dysfunction.