title: Effect of rosuvastatin on repeat heart failure hospitalizations: the CORONA Trial (Controlled Rosuvastatin Multinational Trial in Heart Failure).
abstract: OBJECTIVE
  This study sought to examine the effect of statin therapy hospitalizations for heart failure (HFH) in patients in the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) trial.
  
  
  BACKGROUND
  HFH is an important, frequently recurrent event. Conventional time-to-first event analyses do not take account repeat events. We used a number of statistical approaches to examine the effect of treatment on first and repeat HFH in the CORONA trial.
  
  
  METHODS
  In the CORONA trial, 5,011 patients ≥60 years of age with chronic New York Heart Association functional classes II to IV systolic heart failure resulting from ischemia were randomized to receive rosuvastatin or placebo. Poisson, Andersen-Gill, and negative binomial methods (NB) were used to analyze the effect of rosuvastatin on HFH, and the NB and a parametric joint frailty model (JF) were used to examine this effect while accounting for the competing risk of cardiovascular (CV) death. Rosuvastatin/placebo rate ratios were calculated, both unadjusted and adjusted.
  
  
  RESULTS
  A total of 1,291 patients had 1 or more HFH (750 of these had a single HFH only), and there were a total of 2,408 HFHs. The hazard ratio for the conventional time-to-first event analysis for HFH was 0.91 (95% confidence interval [CI]: 0.82 to 1.02, p = 0.105). In contrast, the NB on repeat hospitalizations gave an unadjusted RR (RR) for HFH of 0.86 (95% CI: 0.75 to 0.99, p = 0.030), adjusted 0.82 (95% CI: 0.72 to 0.92, p = 0.001), and after including CV death as the last event, adjusted RR of 0.85 (95% CI: 0.77 to 0.94, p = 0.001). The JF gave an adjusted RR of 0.82 (95% CI: 0.73 to 0.92, p = 0.001). Similar results were found in analyses of all CV hospitalizations and all-cause hospitalizations.
  
  
  CONCLUSIONS
  When repeat events were included, rosuvastatin was shown to reduce the risk of HFH by approximately 15% to 20%, equating to approximately 76 fewer admissions per 1,000 patients treated over a median 33 months of follow-up. Including repeat events could increase the ability to detect treatment effects in heart failure trials.
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Jennifer K
authors: JK
authors: Rogers
authors: Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors: Pardeep S
authors: PS
authors: Jhund
authors: Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors: Ana-Cristina
authors: AC
authors: Perez
authors: Universitätsklinikum des Saarlandes, Homburg/Saar Germany.
authors: Michael
authors: M
authors: Böhm
authors: Hull York Medical School, Kingston-Upon-Hull, United Kingdom.
authors: John G
authors: JG
authors: Cleland
authors: Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Lars
authors: L
authors: Gullestad
authors: Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: John
authors: J
authors: Kjekshus
authors: University Medical Centre, Groningen, the Netherlands.
authors: Dirk J
authors: DJ
authors: van Veldhuisen
authors: Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors: John
authors: J
authors: Wikstrand
authors: Nordic School of Public Health, Gothenburg, Sweden.
authors: Hans
authors: H
authors: Wedel
authors: Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom. Electronic address: John.McMurray@glasgow.ac.uk.
authors: John J V
authors: JJ
authors: McMurray
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Stuart J
authors: SJ
authors: Pocock
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000150:complications; D011743:Pyrimidines / Q000627:therapeutic use*; D012008:Recurrence; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium
keywords: heart failure; hospitalizations; statins