Effect of Candesartan on Cause-Specific Mortality in Heart Failure Patients Journal Articles uri icon

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  • Background— Patients with heart failure are at increased risk of sudden death and death attributed to progressive pump failure. We assessed the effect of candesartan on cause-specific mortality in patients enrolled in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) program. Methods and Results— The CHARM program consisted of 3 component trials that enrolled patients with symptomatic heart failure: CHARM-Alternative (n=2028; LVEF⩽40% and ACE intolerant), CHARM-Added (n=2548; LVEF⩽40%, already on ACE inhibitors), and CHARM-Preserved (n=3023; LVEF >40%). Patients were randomized to candesartan, titrated to 32 mg QD, or placebo and were followed up for a median of 37.7 months. All deaths were reviewed by a blinded adjudication committee and categorized according to prespecified definitions on the basis of a narrative and source documentation. The number and rate of deaths by cause were calculated for each of the component trials and the overall program. Of all the patients, 8.5% died suddenly, and 6.2% died of progressive heart failure. Candesartan reduced both sudden death (HR 0.85 [0.73 to 0.99], P =0.036) and death from worsening heart failure (HR 0.78 [0.65 to 0.94], P =0.008). These reductions were most apparent in the patients with LVEF⩽40%. Conclusions— Candesartan reduced sudden death and death from worsening heart failure in patients with symptomatic heart failure, although this reduction was most apparent in patients with systolic dysfunction.


  • Solomon, Scott D
  • Wang, Duolao
  • Finn, Peter
  • Skali, Hicham
  • Zornoff, Leonardo
  • McMurray, John JV
  • Swedberg, Karl
  • Yusuf, Salim
  • Granger, Christopher B
  • Michelson, Eric L
  • Pocock, Stuart
  • Pfeffer, Marc A

publication date

  • October 12, 2004

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