CHARM-Overall研究课件（PPT 7页）.ppt

CHARM-Overall:Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Overall Purpose To determine whether the angiotensin II receptor blocker candesartan reduces all-cause mortality in patients with chronic heart failure (CHF) Reference Pfeffer MA, Swedberg K, Granger CB, et al. for the CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003;362:759–66. CHARM-Overall:Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Overall- TRIAL DESIGN - Design Combined data from three parallel multicenter, multinational, randomized, double-blind, placebo-controlled trials Patients 7599 patients aged 18 years with symptomatic CHF (NYHA class II–IV) and: left ventricular ejection fraction (LVEF) 40%, receiving an ACE inhibitor (2548: CHARM-Added trial) or LVEF 40%, but not receiving an ACE inhibitor because of previous intolerance (2028: CHARM-Alternative trial) or LVEF 40% (3023: CHARM-Preserved trial) Follow up and primary endpoint Primary endpoint: all-cause mortality. Mean 37.7 months follow up. Treatment Placebo or candesartan titrated to 32 mg once daily CHARM-Overall:Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Overall- TRIAL DESIGN continued- CHARM-Overall:Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Overall- RESULTS - All-cause mortality reduction in candesartan and placebo groups of borderline significance (23 vs. 25%, hazard ratio 0.91, 95% CI 0.83–1.00, P=0.055) Cardiovascular death significantly reduced (18.2 vs. 20.3%, P=0.012). Noncardiovascular death not significantly different (P=0.45) Combined endpoint of cardiovascular death or hospital admission for CHF significantly reduced (30.2 vs. 34.5%, P0.0001) Hospital admission for CHF significantly reduced (19.9 vs. 24.2%, hazard ratio 0.79,