Background-Patients with heart failure are at increased risk of sudden death and death attributed to progressive pump failure. We assessed the effect of Candesartan on cause-specificmortality in patients enrolled in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity(CHARM) program. Methods and Results-The CHARM program consisted of 3 component trials that enrolled patients with symptomatic heart failure: CHARM-Alternative(n=2028; LVEF=40%and ACE intolerant), CHARM-Added(n=2548; LVEF=40%, already on ACE inhibitors), and CHARM-Preserved(n=3023; LVEF >40%). Patients were randomized to candesartan, titrated to 32 mg QD, or placebo and were followed up for a median of 37.7 months. All deaths were reviewed by a blinded adjudication committee and categorized according to prespecified definitions on the basis of a narrative and source documentation. The number and rate of deaths by cause were calculated for each of the component trials and the overall program. Of all the patients, 8.5%died suddenly, and 6.2%died of progressive heart failure. Candesartan reduced both sudden death (HR 0.85 [0.73 to 0.99], P=0.036) and death from worsening heart failure(HR 0.78[0.65 to 0.94], P=0.008). These reductions were most apparent in the patients with LVEF=40%. Conclusions-Candesartan reduced sudden death and death from worsening heart failure in patients with symptomatic heart failure, although this reduction was most apparent in patients with systolic dysfunction.
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