Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Hawkins
Nathaniel M
NM
Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK. nathawkins@hotmail.com
Wang
Duolao
D
Petrie
Mark C
MC
Pfeffer
Marc A
MA
Swedberg
Karl
K
Granger
Christopher B
CB
Yusuf
Salim
S
Solomon
Scott D
SD
Ostergren
Jan
J
Michelson
Eric L
EL
Pocock
Stuart J
SJ
Maggioni
Aldo P
AP
McMurray
John J V
JJ
D000368:Aged; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology*; D013777:Tetrazoles / Q000627:therapeutic use*
D001562:Benzimidazoles; D001713:Biphenyl Compounds; D001993:Bronchodilator Agents; D013777:Tetrazoles; C081643:candesartan