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Analysing recurrent hospitalizations in heart failure: a review of statistical methodology, with application to CHARM-Preserved

Rogers, J. K. (författare)
Pocock, S. J. (författare)
McMurray, J. J. V. (författare)
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Granger, C. B. (författare)
Michelson, E. L. (författare)
Ostergren, J. (författare)
Karolinska Institutet
Pfeffer, M. A. (författare)
Solomon, S. D. (författare)
Swedberg, Karl, 1944 (författare)
Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine
Yusuf, S. (författare)
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 (creator_code:org_t)
2013-12-18
2014
Engelska.
Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 16:1, s. 33-40
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Aims Heart failure is characterized by recurrent hospitalizations, but often only the first event is considered in clinical trial reports. In chronic diseases, such as heart failure, analysing all events gives a more complete picture of treatment benefit. We describe methods of analysing repeat hospitalizations, and illustrate their value in one major trial. Methods and results The Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved study compared candesartan with placebo in 3023 patients with heart failure and preserved systolic function. The heart failure hospitalization rates were 12.5 and 8.9 per 100 patient-years in the placebo and candesartan groups, respectively. The repeat hospitalizations were analysed using the Andersen-Gill, Poisson, and negative binomial methods. Death was incorporated into analyses by treating it as an additional event. The win ratio method and a method that jointly models hospitalizations and mortality were also considered. Using repeat events gave larger treatment benefits than time to first event analysis. The negative binomial method for the composite of recurrent heart failure hospitalizations and cardiovascular death gave a rate ratio of 0.75 [95% confidence interval (CI) 0.62-0.91, P = 0.003], whereas the hazard ratio for time to first heart failure hospitalization or cardiovascular death was 0.86 (95% CI 0.74-1.00, P = 0.050). Conclusions In patients with preserved EF, candesartan reduces the rate of admissions for worsening heart failure, to a greater extent than apparent from analysing only first hospitalizations. Recurrent events should be routinely incorporated into the analysis of future clinical trials in heart failure.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Nyckelord

Hospitalization
Recurrent events
Heart failure
Clinical trial
Candesartan
VENTRICULAR SYSTOLIC FUNCTION
CONVERTING-ENZYME INHIBITORS
EJECTION
FRACTION
CLINICAL-TRIALS
CANDESARTAN
EVENTS
MORTALITY
MODEL

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