Association of Candesartan vs Losartan With All-Cause Mortality in Patients With Heart Failure

• Published in: JAMA : the journal of the American Medical Association 2011-01, Vol.305 (2), p.175-182
• Main Authors: Eklind-Cervenka, Maria, Benson, Lina, Dahlström, Ulf, Edner, Magnus, Rosenqvist, Mårten, Lund, Lars H
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiotensin Receptor Antagonists - therapeutic use; Antagonist drugs; Benzimidazoles - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cause of Death; Epidemiology; Female; General aspects; Heart; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization; Humans; Losartan - therapeutic use; Male; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries - statistics & numerical data; Risk; Side effects; Survival Analysis; Sweden - epidemiology; Tetrazoles - therapeutic use; Ventricular Dysfunction, Left
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.2010.1949

CONTEXT Angiotensin II receptor blockers (ARBs) reduce combined mortality and hospitalization in patients with heart failure (HF) with reduced left ventricular ejection fraction. Different agents have different affinity for the AT1 receptor and may have different clinical effects, but have not been tested against each other in HF. OBJECTIVE To assess the association of candesartan vs losartan with all-cause mortality in patients with HF. DESIGN, SETTING, AND PATIENTS An HF registry (the Swedish Heart Failure Registry) of 30 254 unique patients registered from 62 hospitals and 60 outpatient clinics between 2000 and 2009. A total of 5139 patients (mean [SD] age, 74 [11] years; 39% women) were treated with candesartan (n = 2639) or losartan (n = 2500). Survival as of December 14, 2009, by ARB agent was analyzed by Kaplan-Meier method and predictors of survival determined by univariate and multivariate proportional hazard regression models, with and without adjustment for propensity scores and interactions. Stratified analyses and quantification of residual confounding were also performed. MAIN OUTCOME MEASURES All-cause mortality at 1 and 5 years. RESULTS One-year survival was 90% (95% confidence interval [CI], 89%-91%) for patients receiving candesartan and 83% (95% CI, 81%-84%) for patients receiving losartan, and 5-year survival was 61% (95% CI, 54%-68%) and 44% (95% CI, 41%-48%), respectively (log-rank P