Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program
Abstract
Background Atrial fibrillation (AF) is frequent in patients with chronic heart failure (CHF). Experimental and small patient studies have demonstrated that blocking the renin-angiotensin-aldosterone system may prevent AF. In the CHARM program, the effects of the angiotensin receptor blocker candesartan on cardiovascular mortality and morbidity were evaluated in a broad spectrum of patients with symptomatic CHF. CHARM provided the opportunity to prospectively determine the effect of candesartan on the incidence of new AF in this CHF population.Methods 7601 patients with symptomatic CHF and reduced or preserved left ventricular systolic function were randomized to candesartan (target dose 32 mg once daily, mean dose 24 mg) or placebo in the 3 component trials of CHARM. The major outcomes were cardiovascular death or CHF hospitalization and all-cause mortality. The incidence of new AF was a prespecified secondary outcome. Median follow-up was 37.7 months. A conditional logistic regression model for stratified data was used.Results 6379 patients (83.9%) did not have AF on their baseline electrocardiogram. Of these, 392 (6.15%) developed AF during follow-up, 177 (5.55%) in the candesartan group and 215 (6.74%) in the placebo group (odds ratio 0.812, 95% CI 0.662-0.998, P = .048). After adjustment for baseline covariates, the odds ratio was 0.802 (95% CI 0.650-0.990, P = .039). There was no heterogeneity of the effects of candesartan in preventing AF between the 3 component trials (P = .57).Conclusions Treatment with the angiotensin receptor blocker candesartan reduced the incidence of AF in a large, broadly-based, population of patients with symptomatic CHF.
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The reduced incidence of AF with ACE inhibitors/ARBs is less evident in patients with HFpEF and is lost in patients without heart failure.
“The reduced incidence of AF with ACE inhibitors/ARBs is less evident in patients with HFpEF 239 and is lost in patients without heart failure.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [239]
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- Authors
- Ducharme, A., Swedberg, K., Pfeffer, M. A., Cohen-Solal, A., Granger, C. B., Maggioni, A. P., Michelson, E. L., McMurray, J. J. V., Olsson, L., Rouleau, J. L., Young, J. B., Olofsson, B., Puu, M., & Yusuf, S.
- Affiliations
- Montreal Heart Institute (CA)
- Sahlgrenska University Hospital (SE)
- Brigham and Women's Hospital (US)
- Duke Medical Center (US)
- Associazione Nazionale Medici Cardiologi Ospedalieri (IT)
- AstraZeneca (United States) (US)
- Western Infirmary (GB)
- Cleveland Clinic (US)
- AstraZeneca (Sweden) (SE)
- Corresponding author
- Ducharme, Anique
- ORCID
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2006-07
- Volume
- 152
- Issue
- 1
- Pages
- 86-92
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2097546089
- Cited by
- 352
- References
- 42
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 12 · 2023: 9 · 2022: 13 · 2021: 10 · 2020: 20 · 2019: 10 · 2018: 11 · 2017: 10 · 2016: 22 · 2015: 14 · 2014: 21 · 2013: 21 · 2012: 13
- FWCI
- 23.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, chronic heart failure, candesartan, angiotensin receptor blockers, renin-angiotensin-aldosterone system blockade, atrial fibrillation prevention, CHARM trial, cardiovascular mortality, heart failure hospitalization
- MeSH terms
- Aged, Atrial Fibrillation, Benzimidazoles, Biphenyl Compounds, Female, Heart Failure, Humans, Male, Middle Aged, Prospective Studies, Renin-Angiotensin System, Tetrazoles, Comorbidity, Logistic Models, Randomized Controlled Trials as Topic, Angiotensin II Type 1 Receptor Blockers
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