Document Detail


Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme.
MedLine Citation:
PMID:  20356870     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Heart failure (HF) and chronic obstructive pulmonary disease are common partners. Bronchodilators are associated with adverse cardiovascular outcomes in patients with pulmonary disease. The outcome of patients with HF prescribed bronchodilators is poorly defined.
METHODS AND RESULTS: The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme randomized 7599 patients with symptomatic HF to receive candesartan or placebo. The relative risk conveyed by bronchodilator therapy was examined using a multivariable Cox proportional hazards model. The prevalence of bronchodilator therapy was similar in patients with reduced and preserved systolic function (respectively, 8.7 vs. 9.2%, P = 0.46). Beta-blocker utilization was markedly lower in patients receiving bronchodilators compared with those without (overall 31.9 vs. 57.6%, P < 0.0001). Bronchodilator use was associated with increased all-cause mortality [HR 1.26 (1.09-1.45), P = 0.0015], cardiovascular death [HR 1.21 (1.03-1.42), P = 0.0216], HF hospitalization [HR 1.49 (1.29-1.72), P < 0.0001], and major adverse cardiovascular events [HR 1.32 (1.17-1.76), P < 0.0001]. The adverse outcomes were consistent in patients with reduced and preserved systolic function. No significant interaction was observed between bronchodilators and beta-blockade with respect to outcomes.
CONCLUSION: Bronchodilator use is a powerful independent predictor of worsening HF and increased mortality in a broad spectrum of patients with HF. Whether this relates to a toxic effect of bronchodilators, underlying pulmonary disease, or both is unclear and warrants further investigation.
Authors:
Nathaniel M Hawkins; Duolao Wang; Mark C Petrie; Marc A Pfeffer; Karl Swedberg; Christopher B Granger; Salim Yusuf; Scott D Solomon; Jan Ostergren; Eric L Michelson; Stuart J Pocock; Aldo P Maggioni; John J V McMurray;
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-03-31
Journal Detail:
Title:  European journal of heart failure     Volume:  12     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-25     Completed Date:  2010-08-20     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  557-65     Citation Subset:  IM    
Affiliation:
Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK. nathawkins@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Benzimidazoles / therapeutic use*
Bronchodilator Agents / therapeutic use*
Comorbidity
Female
Heart Failure / epidemiology*,  mortality
Humans
Male
Middle Aged
Prognosis
Proportional Hazards Models
Pulmonary Disease, Chronic Obstructive / drug therapy,  epidemiology*
Tetrazoles / therapeutic use*
Chemical
Reg. No./Substance:
0/Benzimidazoles; 0/Bronchodilator Agents; 0/Tetrazoles; S8Q36MD2XX/candesartan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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