The development of heart failure in patients with stable angina pectoris

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

Abstract

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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