Heart failure registry can be differentiated between the ARBs, candesartan and losartan. Mortality in heart failure patients with impaired left ventricular ejection fraction (LVEF) was signiﬁcantly reduced with candesartan in comparison to losartan in a large population of patients in everyday care. Fifteen per cent of the patients in this registry study of Swedish patients had diabetes; as could be expected from broad estimations that one in five diabetic patients will develop heart failure in the course of their disease. Heart failure and diabetes are inextricably linked.
Managing heart failure patients through angiotension receptor blockers. Because of this and the high incidence and financial burden of these conditions, preventing heart failure patients from developing diabetes; preventing those with diabetes from developing heart failure; and improving the prognosis of those with diabetes and heart failure are important therapeutic goals. Most algorithms for the pharmacological management of heart failure recommend the use of an angiotensin ll receptor antagonist (ARB) in ACE-intolerant patients. Nurse Call Systems Sydney help deal medical emergencies.
Currently, only candesartan and valsartan have evidence to support their use in heart failure, with positive outcome data from the CHARM group of studies when candesartan was used together with an ACE inhibitor and a B-blocker. In contrast, valsartan, in the VAL-HEFT study, when used with an ACE inhibitor and a beta-blocker, led to an adverse trend of increasing mortality and morbidity, which requires the Nurse Call Systems Sydney?
The positive results for candesartan in this latest evaluation in a ‘real-world’ situation were maintained after adjustment for numerous clinical variables, including dose (the comparative losartan dose was set at 150 mg/day in accordance with the HEAAL study’), selection bias and outcome. In the evaluation of doses in this study, 70% of the candesartan group received the target dose defined as 32 or 50 mg/day.
The benefit in all-cause mortality with candesartan was seen in both the one and five year survival data of patients with a LVEF of less than 40% and in those with a LVEF of 40% or more. The one-year survival was 90% for patients receiving candesartan and 83% for patients receiving losartan. The five-year survival was 61% for candesartan-treated patients and 44% for losartan-treated patients.
The hazard ratio (HR) for all-cause mortality of losartan compared with candesartan was 1.43 overall, and similar in those patients with impaired LVEF and those with LVEF greater than 40% (HR of candesartan compared to losartan was 0.70). As the patients included in this study were being treated both in hospital and on an outpatient basis (54.5% of patients), overall mortality was low (1 329 deaths in the 5139 patients included in the analysis).