Angiotensin II antagonist improves outcomes in all classes of heart failure
Patients with symptomatic heart failure benefit from treatment with the angiotensin II antagonist candesartan (Amias). It reduces cardiovascular
mortality and hospital admissions, according to data reported at the
European Society of Cardiology congress held in Vienna this week.
The CHARM (candesartan in heart failure — assessment of reduction
in mortality and morbidity) study comprised three separate trials. The
first included patients with low ejection fraction (EF) who were intolerant
of angiotensin converting enzyme (ACE) inhibitors, the second included
those with low EF who were already treated with ACE inhibitors and the
third looked at patients with preserved EF, some of whom were also treated
with ACE inhibitors. Patients in each group were randomised to candesartan
(target dose 32mg) or placebo in addition to standard therapy,
The CHARM-Alternative trial (2,028 patients with EF < 40 per cent
and intolerance to an ACE inhibitor) revealed that treatment with candesartan
achieved a 23 per cent reduction in the risk of cardiovascular death
or hospital admission for heart failure (P=0.0004). Patients given candesartan
in addition to an ACE inhibitor (CHARM-Added trial; 2,548 patients with
EF < 40 per cent) showed a 15 per cent reduction in cardiovascular
deaths or hospital admission (P=0.011) compared with conventional treatment
alone.
Professor John McMurray, professor of cardiology at Glasgow University
and principal investigator of the CHARM-Added study, noted: “The
finding that candesartan improved outcome, even when added to full conventional
therapy, is an important advance in the treatment of these very sick
patients.”
Patients with preserved EF — a group generally excluded from previous
heart failure studies — also showed a trend towards a reduction
in cardiovascular deaths or hospital admissions in the CHARM-Preserved
trial (3,023 patients with EF > 40 per cent), although this did not
reach statistical significance. The number of hospital admissions for
CHF was 566 in the placebo group compared with 402 in patients treated
with candesartan (P=0.014).
Professor McMurray acknowledged that pharmacists play a crucial part
in initiating patients with heart failure on the complex multidrug regimen
needed to improve outcomes. “Most cardiology teams now use pharmacy
expertise to optimise patient compliance with the increasingly complex
regimens used to treat heart failure. Evidence from trials has demonstrated
the value of this input, particularly in educating patients about their
drug treatments and in finding ways to help patients take their drugs
on a regular basis,” he said.
The CHARM studies are published in The Lancet (2003;362:759, 767, 772
and 777). |
