Tags

Type your tag names separated by a space and hit enter

Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme.
Lancet 2003; 362(9386):759-66Lct

Abstract

BACKGROUND

Patients with chronic heart failure (CHF) are at high risk of cardiovascular death and recurrent hospital admissions. We aimed to find out whether the use of an angiotensin-receptor blocker could reduce mortality and morbidity.

METHODS

In parallel, randomised, double-blind, controlled, clinical trials we compared candesartan with placebo in three distinct populations. We studied patients with left-ventricular ejection fraction (LVEF) 40% or less who were not receiving angiotensin-converting-enzyme inhibitors because of previous intolerance or who were currently receiving angiotensin-converting-enzyme inhibitors, and patients with LVEF higher than 40%. Overall, 7601 patients (7599 with data) were randomly assigned candesartan (n=3803, titrated to 32 mg once daily) or matching placebo (n=3796), and followed up for at least 2 years. The primary outcome of the overall programme was all-cause mortality, and for all the component trials was cardiovascular death or hospital admission for CHF. Analysis was by intention to treat.

FINDINGS

Median follow-up was 37.7 months. 886 (23%) patients in the candesartan and 945 (25%) in the placebo group died (unadjusted hazard ratio 0.91 [95% CI 0.83-1.00], p=0.055; covariate adjusted 0.90 [0.82-0.99], p=0.032), with fewer cardiovascular deaths (691 [18%] vs 769 [20%], unadjusted 0.88 [0.79-0.97], p=0.012; covariate adjusted 0.87 [0.78-0.96], p=0.006) and hospital admissions for CHF (757 [20%] vs 918 [24%], p<0.0001) in the candesartan group. There was no significant heterogeneity for candesartan results across the component trials. More patients discontinued candesartan than placebo because of concerns about renal function, hypotension, and hyperkalaemia.

INTERPRETATION

Candesartan was generally well tolerated and significantly reduced cardiovascular deaths and hospital admissions for heart failure. Ejection fraction or treatment at baseline did not alter these effects.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. mpfeffer@rics.bwh.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

13678868

Citation

Pfeffer, Marc A., et al. "Effects of Candesartan On Mortality and Morbidity in Patients With Chronic Heart Failure: the CHARM-Overall Programme." Lancet (London, England), vol. 362, no. 9386, 2003, pp. 759-66.
Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet. 2003;362(9386):759-66.
Pfeffer, M. A., Swedberg, K., Granger, C. B., Held, P., McMurray, J. J., Michelson, E. L., ... Pocock, S. (2003). Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet (London, England), 362(9386), pp. 759-66.
Pfeffer MA, et al. Effects of Candesartan On Mortality and Morbidity in Patients With Chronic Heart Failure: the CHARM-Overall Programme. Lancet. 2003 Sep 6;362(9386):759-66. PubMed PMID: 13678868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. AU - Pfeffer,Marc A, AU - Swedberg,Karl, AU - Granger,Christopher B, AU - Held,Peter, AU - McMurray,John J V, AU - Michelson,Eric L, AU - Olofsson,Bertil, AU - Ostergren,Jan, AU - Yusuf,Salim, AU - Pocock,Stuart, AU - ,, PY - 2003/9/19/pubmed PY - 2003/10/28/medline PY - 2003/9/19/entrez SP - 759 EP - 66 JF - Lancet (London, England) JO - Lancet VL - 362 IS - 9386 N2 - BACKGROUND: Patients with chronic heart failure (CHF) are at high risk of cardiovascular death and recurrent hospital admissions. We aimed to find out whether the use of an angiotensin-receptor blocker could reduce mortality and morbidity. METHODS: In parallel, randomised, double-blind, controlled, clinical trials we compared candesartan with placebo in three distinct populations. We studied patients with left-ventricular ejection fraction (LVEF) 40% or less who were not receiving angiotensin-converting-enzyme inhibitors because of previous intolerance or who were currently receiving angiotensin-converting-enzyme inhibitors, and patients with LVEF higher than 40%. Overall, 7601 patients (7599 with data) were randomly assigned candesartan (n=3803, titrated to 32 mg once daily) or matching placebo (n=3796), and followed up for at least 2 years. The primary outcome of the overall programme was all-cause mortality, and for all the component trials was cardiovascular death or hospital admission for CHF. Analysis was by intention to treat. FINDINGS: Median follow-up was 37.7 months. 886 (23%) patients in the candesartan and 945 (25%) in the placebo group died (unadjusted hazard ratio 0.91 [95% CI 0.83-1.00], p=0.055; covariate adjusted 0.90 [0.82-0.99], p=0.032), with fewer cardiovascular deaths (691 [18%] vs 769 [20%], unadjusted 0.88 [0.79-0.97], p=0.012; covariate adjusted 0.87 [0.78-0.96], p=0.006) and hospital admissions for CHF (757 [20%] vs 918 [24%], p<0.0001) in the candesartan group. There was no significant heterogeneity for candesartan results across the component trials. More patients discontinued candesartan than placebo because of concerns about renal function, hypotension, and hyperkalaemia. INTERPRETATION: Candesartan was generally well tolerated and significantly reduced cardiovascular deaths and hospital admissions for heart failure. Ejection fraction or treatment at baseline did not alter these effects. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/13678868/Effects_of_candesartan_on_mortality_and_morbidity_in_patients_with_chronic_heart_failure:_the_CHARM_Overall_programme_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140673603142821 DB - PRIME DP - Unbound Medicine ER -