1,721,089 research outputs found
Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom
No full textBackground: There are few large population-based studies of the incidence and outcome of heart failure where the diagnosis of heart failure
(HF) has been made by a General Practitioner (GP) in the community.
Methods: From the General Practice Research Database in the UK, we selected a population of 686,884 people 45 years or older. Incident
cases of HF in 1991 were classified definite HF, possible HF, or a first prescription of diuretics without a diagnosis of HF. The population was
followed for 3-year mortality.
Results: A total of 6478 patients had definite HF (mean age 77.2 years, 55.5% women), 14,050 had possible HF and 6076 persons were
prescribed diuretics without a definite or possible diagnosis of HF. The overall incidence of definite HF was 9.3/1000 persons/year and of
possible HF 20.2/1000 persons/year. Diuretics were prescribed for the first time for other reasons for 8.7 persons/1000/year. The incidence of
HF was higher in men. The incidence of definite HF increased with age. Survival curves showed higher mortality rates in the first 3 months
after the diagnosis of HF. One-year cumulative probability of death for patients with definite HF was 15.9 times higher in men and 14.7 times
higher in women in comparison with the UK population.
Conclusion: The diagnosis of HF by a GP successfully identifies patients at high risk of death, comparable to patients with HF identified by
cardiologists on the basis of defined diagnostic criteria. HF is common in the general population, increases sharply with age, and has a poor
prognosis
Comparison of the effects of metoprolol and carvedilol on symptoms, well.-being, and quality-adjusted life-years: A description of the patient-journey in COMET
No full textComparison of the effects of metoprolol and carvedilol on symptoms, well.-being, and quality-adjusted life-years: A description of the patient-journey in COMET.
No full textConsistent survival benefit of carvedilol over metoprolol irrespective of baseline characteristics of heart failure patients – Mode of death evaluation in COMET.
No full textAssociation of deranged adrenal steroid metabolism with anemia in chronic heart failure.
No full textEffects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial.
No full textBACKGROUND: Angiotensin-receptor blockers (ARBs) are effective treatments for patients with heart failure, but the relation between dose and clinical outcomes has not been explored. We compared the effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure.
METHODS: This double-blind trial was undertaken in 255 sites in 30 countries. 3846 patients with heart failure of New York Heart Association class II-IV, left-ventricular ejection fraction 40% or less, and intolerance to angiotensin-converting-enzyme (ACE) inhibitors were randomly assigned to losartan 150 mg (n=1927) or 50 mg daily (n=1919). Allocation was by block randomisation stratified by centre and presence or absence of beta-blocker therapy, and all patients and investigators were masked to assignment. The primary endpoint was death or admission for heart failure. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00090259.
FINDINGS: Six patients in each group were excluded because of poor data quality. With 4.7-year median follow-up in each group (IQR 3.7-5.5 for losartan 150 mg; 3.4-5.5 for losartan 50 mg), 828 (43%) patients in the 150 mg group versus 889 (46%) in the 50 mg group died or were admitted for heart failure (hazard ratio [HR] 0.90, 95% CI 0.82-0.99; p=0.027). For the two primary endpoint components, 635 patients in the 150 mg group versus 665 in the 50 mg group died (HR 0.94, 95% CI 0.84-1.04; p=0.24), and 450 versus 503 patients were admitted for heart failure (0.87, 0.76-0.98; p=0.025). Renal impairment (n=454 vs 317), hypotension (203 vs 145), and hyperkalaemia (195 vs 131) were more common in the 150 mg group than in the 50 mg group, but these adverse events did not lead to significantly more treatment discontinuations in the 150 mg group.
INTERPRETATION: Losartan 150 mg daily reduced the rate of death or admission for heart failure in patients with heart failure, reduced left-ventricular ejection fraction, and intolerance to ACE inhibitors compared with losartan 50 mg daily. These findings show the value of up-titrating ARB doses to confer clinical benefit.
FUNDING: Merck (USA)
The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET
No full textLack of heart rate effects on the mortality benefits of carvedilol compared to metoprolol in the patients with heart failure: Results from the Carvedilol or Metoprolol European trial (COMET)
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