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European Journal of Heart Failure 2007 9(3):234-242; doi:10.1016/j.ejheart.2006.09.002
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© 2007 European Society of Cardiology

The development of heart failure in patients with stable angina pectoris{star}

George C. Suttona, Jan Erik Otterstadb, Bridget-Anne Kirwanc, Zoltán Vokód, Sophie de Brouwerc, Jacobus Lubsenc,e, Philip A. Poole-Wilsona,* ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) investigators

a Cardiac Medicine, National Heart and Lung Institute Imperial College London, Dovehouse Street, London SW3 6LY, UK
b Division of Cardiology Vestfold Hospital, Toensberg, Norway
c SOCAR Research Nyon, Switzerland
d Department of Biostatistics and Epidemiology, School of Public Health, Medical and Health Sciences Centre University of Debrecen, Debrecen, Hungary
e Department of Epidemiology and Biostatistics Erasmus Medical Centre, Rotterdam, The Netherlands

* Corresponding author. Tel.: +44 20 7351 8179; fax: +44 20 7351 8113. E-mail address: p.poole-wilson{at}imperial.ac.uk


  Abstract

Background: To describe the clinical characteristics of patients with stable angina pectoris who develop heart failure and the events preceding its onset.

Methods and results: Of 7665 patients with stable angina in the ACTION trial, which compared long-acting nifedipine to placebo, 207 (2.7%) developed heart failure (HF) during a mean follow-up of 4.9years. Those who developed HF were significantly (P<0.05) older, more often had diabetes, had a more extensive history of cardiovascular disease, lower ejection fractions, a higher serum creatinine and glucose, a lower haemoglobin, and were more often on blood pressure lowering drugs. A cardiac event or an intervention (n=155), a significant non-cardiac infection (n=19) or poor control of hypertension (n=12) preceded the development of HF in 186/207 cases (90%). There was no obvious precipitating factor in the remaining 21 patients (10%). Myocardial infarction increased the risk of the development of new HF within one week more than 100-fold. Nifedipine reduced the incidence of HF by 29% (P=0.015).

Conclusions: The development of heart failure is uncommon in patients with stable angina, and even less so in the absence of an obvious precipitating factor.

Key Words: Angina pectoris • Heart failure • Randomised controlled trial • Calcium channel blockers

Received April 7, 2006; Revised August 1, 2006; Accepted September 5, 2006

{star} The ACTION trial was supported by Bayer Healthcare, AG, Wuppertal, Germany.


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