March 31, 2010
View Full PaperBaseline Characteristics and Outcomes of Patients with Heart Failure Receiving Bronchodilators in the CHARM Programme
Key Result
Bronchodilator use in patients with heart failure was associated with increased all-cause mortality (HR 1.26; 95% CI 1.09-1.45; P=0.0015) and major adverse cardiovascular events.
Study Design
Type
Cohort (n=7,599)
Multicenter
Yes
Structured PICO
Does bronchodilator therapy increase adverse cardiovascular outcomes in patients with symptomatic heart failure?
P
Population
7,599 patients with symptomatic heart failure (both reduced and preserved systolic function) from the CHARM programme
I
Intervention
Bronchodilator therapy
C
Comparator
No bronchodilator therapy
O
Outcome
All-cause mortality, cardiovascular death, heart failure hospitalization, and major adverse cardiovascular eventshard clinical
Bronchodilator use is an independent predictor of increased mortality and worsening heart failure in patients with symptomatic HF, regardless of ejection fraction.
Main Result
Effect estimate: HR 1.26 (95% CI 1.09-1.45)
p-value: p=0.0015
Limitations
- Unclear whether adverse outcomes relate to a toxic effect of bronchodilators, underlying pulmonary disease, or both
Abstract
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.