title: Clinical characteristics and outcomes of patients with angina and heart failure in the CHARM (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity) Programme.
abstract: OBJECTIVE
  To investigate the relationship between angina pectoris and fatal and non-fatal clinical outcomes in heart failure with reduced and preserved ejection fraction (HF-REF and HF-PEF, respectively).
  
  
  RESULTS
  Of 7599 patients in the CHARM program, 5408 had ischaemic heart disease; 3855 had HF-REF (ejection fraction ≤45%) and 1553 had HF-PEF. These patients were separated into three groups: no history of angina, previous angina, and current angina. Three coronary outcomes were examined: fatal or non-fatal myocardial infarction (MI); MI or hospitalization for unstable angina (UA); and MI, UA or coronary revascularization. The composite heart failure outcome of cardiovascular death or heart failure hospitalization (HFH) was also analysed, along with its components and all-cause mortality. New York Heart Association functional class was worse in both HF-REF and HF-PEF patients with current angina compared with patients without angina (P < 0.001 and P = 0.005 respectively), despite similar clinical examination findings and ejection fraction. Patients with current angina had a higher risk of all three coronary outcomes (adjusted hazard ratios ranging from 1.8-3.1) than those without angina but did not have a higher risk of heart failure outcomes or all-cause mortality.
  
  
  CONCLUSIONS
  In patients with heart failure current angina is associated with significantly more functional limitation and a higher risk of coronary events, across the spectrum of left ventricular ejection fraction.
authors: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK; Golden Jubilee National Hospital, Glasgow, UK.
authors: Athar A
authors: AA
authors: Badar
authors: Ana C
authors: AC
authors: Perez-Moreno
authors: Nathaniel M
authors: NM
authors: Hawkins
authors: Alan P T
authors: AP
authors: Brunton
authors: Pardeep S
authors: PS
authors: Jhund
authors: Chih M
authors: CM
authors: Wong
authors: Scott D
authors: SD
authors: Solomon
authors: Christopher B
authors: CB
authors: Granger
authors: Salim
authors: S
authors: Yusuf
authors: Marc A
authors: MA
authors: Pfeffer
authors: Karl
authors: K
authors: Swedberg
authors: Roy S
authors: RS
authors: Gardner
authors: Mark C
authors: MC
authors: Petrie
authors: John J V
authors: JJ
authors: McMurray
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D009204:Myocardial Revascularization; D063868:Patient Outcome Assessment; D013318:Stroke Volume / Q000502:physiology; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan
keywords: Angina; Heart failure