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Taking pills, even if placebo, predicts better survival in heart failure

h blood to the body's tissues, and thereby to provide them with oxygen and nutrients. The typical heart failure patient takes an average of six different medications to control their symptoms and improve their quality of life, the researchers said.

An estimated 5 million Americans suffer from the condition, with 400,000 new cases reported each year. Half of the patients die within five years of the diagnosis, typically after repeated hospitalizations.

According to Granger, about two-thirds of all hospital admissions for heart failure are preventable and due to non-compliance in such areas as diet, close attention to symptoms and adherence to drug regimens. Since it has been known that poor adherence can limit the effectiveness of medications for heart failure patients, the researchers studied the issue in a large double-blind, randomized controlled clinical trial of the ARB candesartan.

The five year trial, Candesartan in Heart Failure Assessment of Mortality and Morbidity (CHARM), was one of the largest such trials and had an average patient follow-up of 38 months. Adherence was measured as the proportion of time patients took at least 80 percent of the study medication.

Two earlier heart studies the Coronary Drug Project in 1980 Beta-Blockers in Heart Attack in 1982 showed similar patterns as the new Duke analysis, and according to Granger, researchers have attempted over the years without success to in explain the beneficial effects of adherence in those studies. Researchers have studied such non-medical variables as martial status, stress, education and social isolation, but could not uncover a statistical link to adherence, she said.

"The consensus is that there must be something that differentiates people who adhere from people who do not," Granger said. "We don't know why, but they are different in terms of outcome."

Even without an understanding of the reasons for this phenomenon, Granger does believe that im
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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
9-Nov-2004


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