The development of heart failure in patients with stable angina pectoris

The development of heart failure in patients with stable angina pectoris

George C. Sutton a, Jan Erik Otterstad b, Bridget-Anne Kirwan c, Zoltán Vokó d,
Sophie de Brouwer c, Jacobus Lubsen c,e, Philip A. Poole-Wilson a,⁎
On behalf of the ACTION (A Coronary disease Trial Investigating
Outcome with Nifedipine GITS) investigators

Cardiac Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK

b Division of Cardiology, Vestfold Hospital, Toensberg, Norway

c SOCAR Research, Nyon, Switzerland

d Department of Biostatistics and Epidemiology, School of Public Health, Medical and Health Sciences Centre, University of Debrecen, Debrecen, Hungary

e Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands

Received 7 April 2006; received in revised form 1 August 2006; accepted 5 September 2006


Background: To describe the clinical characteristics of patients with stable angina pectoris who develop heart failure and the events preceding ts onset.

Methods and results: Of 7665 patients with stable angina in the ACTION trial, which compared long-acting nifedipine to placebo, 207 (2.7%) developed heart failure (HF) during a mean follow-up of 4.9 years. Those who developed HF were significantly (Pb0.05) older, more often had diabetes, had a more extensive history of cardiovascular disease, lower ejection fractions, a higher serum creatinine and glucose, a lower haemoglobin, and were more often on blood pressure lowering drugs. A cardiac event or an intervention (n=155), a significant noncardiac infection (n=19) or poor control of hypertension (n=12) preceded the development of HF in 186/207 cases (90%).

There was no obvious precipitating factor in the remaining 21 patients (10%). Myocardial infarction increased the risk of the development of new HF within one week more than 100-fold. Nifedipine reduced the incidence of HF by 29% (P=0.015).

Conclusions: The development of heart failure is uncommon in patients with stable angina, and even less so in the absence of an obvious
precipitating factor.

© 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Keywords: Angina pectoris; Heart failure; Randomised controlled trial; Calcium channel blockers

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