title: Influence of previous heart failure hospitalization on cardiovascular events in patients with reduced and preserved ejection fraction.
abstract: BACKGROUND
  Hospitalization for acute heart failure (HF) is associated with high rates of subsequent mortality and readmission. We assessed the influence of the time interval between previous HF hospitalization and randomization in the Candesartan in Heart failure: Reduction in Mortality and morbidity (CHARM) trials on clinical outcomes in patients with both reduced and preserved ejection fraction.
  
  
  RESULTS
  CHARM enrolled 7599 patients with New York Heart Association class II to IV HF, of whom 5426 had a history of previous HF hospitalization. Cox proportional hazards regression models were used to assess the association between time from previous HF hospitalization and randomization and the primary outcome of cardiovascular death or unplanned admission to hospital for the management of worsening HF during a median of 36.6 months. For patients with HF and reduced or preserved ejection fraction, rates of cardiovascular mortality and HF hospitalization were higher among patients with previous HF hospitalization than those without. The risk for mortality and hospitalization varied inversely with the time interval between hospitalization and randomization. Rates were higher for patients with HF and reduced ejection fraction within each category. Event rates for those with HF with preserved ejection fraction and a HF hospitalization in the 6 months before randomization were comparable with the rate in patients with HF and reduced ejection fraction with no previous HF hospitalization.
  
  
  CONCLUSIONS
  Rates of cardiovascular death or HF hospitalization are greatest in those who have been previously hospitalized for HF. Independent of EF, rates of death and readmission decline as time from HF hospitalization to trial enrollment increased. Recent HF hospitalization identifies a high-risk population for future clinical trials in HF and reduced ejection fraction and HF with preserved ejection fraction.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00634400.
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Bello
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.).
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (N.A.B., B.C., A.S.D., M.A.P., S.D.S.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC (C.B.G.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.Y.); and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden (K.S.). ssolomon@rics.bwh.harvard.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001562:Benzimidazoles / Q000008:administration & dosage*; D001713:Biphenyl Compounds; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013777:Tetrazoles / Q000008:administration & dosage*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan
keywords: clinical trials; heart failure; hospitalization; outcomes assessment