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Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme
Author(s) -
Hawkins Nathaniel M.,
Wang Duolao,
Petrie Mark C.,
Pfeffer Marc A.,
Swedberg Karl,
Granger Christopher B.,
Yusuf Salim,
Solomon Scott D.,
Östergren Jan,
Michelson Eric L.,
Pocock Stuart J.,
Maggioni Aldo P.,
McMurray John J.V.
Publication year - 2010
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfq040
Subject(s) - medicine , candesartan , bronchodilator , heart failure , adverse effect , cardiology , placebo , randomized controlled trial , blood pressure , asthma , angiotensin ii , alternative medicine , pathology
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.