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Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial.
Lancet 2003; 362(9386):777-81Lct

Abstract

BACKGROUND

Half of patients with chronic heart failure (CHF) have preserved left-ventricular ejection fraction (LVEF), but few treatments have specifically been assessed in such patients. In previous studies of patients with CHF and low LVEF or vascular disease and preserved LVEF, inhibition of the renin-angiotensin system is beneficial. We investigated the effect of addition of an angiotensin-receptor blocker to current treatments.

METHODS

Between March, 1999, and July, 2000, we randomly assigned 3023 patients candesartan (n=1514, target dose 32 mg once daily) or matching placebo (n=1509). Patients had New York Heart Association functional class II-IV CHF and LVEF higher than 40%. The primary outcome was cardiovascular death or admission to hospital for CHF. Analysis was done by intention to treat.

FINDINGS

Median follow-up was 36.6 months. 333 (22%) patients in the candesartan and 366 (24%) in the placebo group experienced the primary outcome (unadjusted hazard ratio 0.89 [95% CI 0.77-1.03], p=0.118; covariate adjusted 0.86 [0.74-1.0], p=0.051). Cardiovascular death did not differ between groups (170 vs 170), but fewer patients in the candesartan group than in the placebo group were admitted to hospital for CHF once (230 vs 279, p=0.017) or multiple times. Composite outcomes that included non-fatal myocardial infarction and non-fatal stroke showed similar results to the primary composite (388 vs 429; unadjusted 0.88 [0.77-1.01], p=0.078; covariate adjusted 0.86 [0.75-0.99], p=0.037).

INTERPRETATION

Candesartan has a moderate impact in preventing admissions for CHF among patients who have heart failure and LVEF higher than 40%.

Authors+Show Affiliations

McMaster Clinic, Room 252, Hamilton General Hospital, 237 Barton Street East, ON, L8L 2X2, Hamilton, Canada. yusufs@mcmaster.caNo 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
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

13678871

Citation

Yusuf, Salim, et al. "Effects of Candesartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction: the CHARM-Preserved Trial." Lancet (London, England), vol. 362, no. 9386, 2003, pp. 777-81.
Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362(9386):777-81.
Yusuf, S., Pfeffer, M. A., Swedberg, K., Granger, C. B., Held, P., McMurray, J. J., ... Ostergren, J. (2003). Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet (London, England), 362(9386), pp. 777-81.
Yusuf S, et al. Effects of Candesartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction: the CHARM-Preserved Trial. Lancet. 2003 Sep 6;362(9386):777-81. PubMed PMID: 13678871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. AU - Yusuf,Salim, 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 - ,, PY - 2003/9/19/pubmed PY - 2003/10/28/medline PY - 2003/9/19/entrez SP - 777 EP - 81 JF - Lancet (London, England) JO - Lancet VL - 362 IS - 9386 N2 - BACKGROUND: Half of patients with chronic heart failure (CHF) have preserved left-ventricular ejection fraction (LVEF), but few treatments have specifically been assessed in such patients. In previous studies of patients with CHF and low LVEF or vascular disease and preserved LVEF, inhibition of the renin-angiotensin system is beneficial. We investigated the effect of addition of an angiotensin-receptor blocker to current treatments. METHODS: Between March, 1999, and July, 2000, we randomly assigned 3023 patients candesartan (n=1514, target dose 32 mg once daily) or matching placebo (n=1509). Patients had New York Heart Association functional class II-IV CHF and LVEF higher than 40%. The primary outcome was cardiovascular death or admission to hospital for CHF. Analysis was done by intention to treat. FINDINGS: Median follow-up was 36.6 months. 333 (22%) patients in the candesartan and 366 (24%) in the placebo group experienced the primary outcome (unadjusted hazard ratio 0.89 [95% CI 0.77-1.03], p=0.118; covariate adjusted 0.86 [0.74-1.0], p=0.051). Cardiovascular death did not differ between groups (170 vs 170), but fewer patients in the candesartan group than in the placebo group were admitted to hospital for CHF once (230 vs 279, p=0.017) or multiple times. Composite outcomes that included non-fatal myocardial infarction and non-fatal stroke showed similar results to the primary composite (388 vs 429; unadjusted 0.88 [0.77-1.01], p=0.078; covariate adjusted 0.86 [0.75-0.99], p=0.037). INTERPRETATION: Candesartan has a moderate impact in preventing admissions for CHF among patients who have heart failure and LVEF higher than 40%. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/13678871/Effects_of_candesartan_in_patients_with_chronic_heart_failure_and_preserved_left_ventricular_ejection_fraction:_the_CHARM_Preserved_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)14285-7 DB - PRIME DP - Unbound Medicine ER -