© 2005 European Society of Cardiology
Patient perception of the effect of treatment with candesartan in heart failure. Results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme
a Department of Cardiology, Western Infirmary Glasgow, Scotland G11 6NT, United Kingdom
b Brigham and Women's Hospital Boston, MA, USA
c Duke University Medical Center Durham, NC, USA
d Case Western Reserve University, Cleveland and VA Medical Center OH, USA
e Hamilton General Hospital Hamilton, Ontario, Canada
f University of Washington Seattle, WA, USA
g Medicine, Cleveland Clinic Foundation Cleveland, USA
h AstraZeneca LP Wilmington, DE, USA
i Karolinska Hospital Stockholm, SE, Sweden
j AstraZeneca, R and D Mölndal, Sweden
k HGM-McMaster Clinic Hamilton, Ontario, Canada
l Department of Medicine, Sahlgrenska University Hospital/Östra Göteborg, Sweden
* Corresponding author. Tel.: +44 141 211 1838; Fax: +44 141 211 2252. E-mail address: j.mcmurray{at}bio.gla.ac.uk
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Abstract |
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Aims: To evaluate the effect of the angiotensin receptor blocker candesartan on patients' perception of symptoms, using the McMaster Overall treatment evaluation (OTE), in a broad spectrum of patients with chronic heart failure (CHF).
Methods and results: Patients with symptomatic CHF, randomised in the CHARM Programme in North America (n=2498), were studied. OTE was assessed at baseline, at 6, 14 and 26 months and the patient's final or closing visit. Patient's status was classified as "improved (score +1 to +7)", "unchanged (score 0)" or "deteriorated (score–1 to –7)" at the end of the study compared to baseline. Both a simple "last visit carried forward" (LVCF) analysis and "worst rank carried forward" (WRCF) analysis (where patients who died were allocated the worst OTE score) were used. In the LVCF analysis, compared to placebo, more candesartan patients improved (37.7% versus 33.5%) and fewer worsened (10.8% versus 12.0%) in OTE (p=0.017). The WRCF analysis also showed better overall OTE scores with candesartan compared to placebo (p=0.029). There was no heterogeneity in the response to candesartan between the CHARM component trials or across four exploratory sub-groups (age, sex, NYHA class and beta-blocker).
Conclusions: Candesartan was shown to be better than placebo, when using the McMaster OTE to measure patient perception of treatment. More patients treated with candesartan reported improvement and fewer reported deterioration. This benefit was obtained when candesartan was added to extensive background therapy and is consistent with the benefits of candesartan on NYHA class, hospital admission for worsening heart failure and mortality.
Key Words: Heart failure • Symptoms • Functional capacity • Quality of life • Angiotensin receptor blockers
Received November 30, 2004; Revised January 5, 2005; Accepted January 27, 2005
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