Days alive and out of hospital and the patient journey in patients with heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program

Ariti, C. A., Cleland, J. G.F. , Pocock, S. J., Pfeffer, M. A., Swedberg, K., Granger, C. B., McMurray, J. J.V. , Michelson, E. L., Östergren, J. and Yusuf, S. (2011) Days alive and out of hospital and the patient journey in patients with heart failure: insights from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. American Heart Journal, 162(5), pp. 900-906. (doi: 10.1016/j.ahj.2011.08.003) (PMID:22093207)

Full text not currently available from Enlighten.

Abstract

Background: Conventional composite outcomes in heart failure (HF) trials, for example, time to cardiovascular death or first HF hospitalization, have recognized limitations. We propose an alternative outcome, days alive and out of hospital (DAOH), which incorporates mortality and all hospitalizations into a single measure. A refinement, the patient journey, also uses functional status (New York Heart Association [NYHA] class) measured during follow-up. The CHARM program is used to illustrate the methodology. Methods: CHARM randomized 7,599 patients with symptomatic HF to placebo or candesartan, with median follow-up of 38 months. We related DAOH and percent DAOH (ie, percentage of time spent alive and out of hospital) to treatment using linear regression adjusting for follow-up time. Results: Mean increase in DAOH for patients on candesartan versus placebo was 24.1 days (95% CI 9.8-38.3 days, P < .001). The corresponding mean increase in percent DAOH was 2.0% (95% CI 0.8%-3.1%, P < .001). These findings were dominated by reduced mortality (23 days) but enhanced by reduced time in hospital (1 day). Percent time spent in hospital because of HF was reduced by 0.10% (95% CI 0.04%-0.14%, P < .001). The patient journey analysis showed that patients in the candesartan group spent more follow-up time in NYHA classes I and II and less in NYHA class IV. Conclusions: Days alive and out of hospital, especially percent DAOH, provide a valuable tool for summarizing the overall absolute treatment effect on mortality and morbidity. In future HF trials, percent DAOH can provide a useful alternative perspective on the effects of treatment.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Cleland, Professor John
Authors: Ariti, C. A., Cleland, J. G.F., Pocock, S. J., Pfeffer, M. A., Swedberg, K., Granger, C. B., McMurray, J. J.V., Michelson, E. L., Östergren, J., and Yusuf, S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:American Heart Journal
Publisher:Elsevier
ISSN:0002-8703
ISSN (Online):1097-6744
Published Online:07 October 2011

University Staff: Request a correction | Enlighten Editors: Update this record