Skip to main content

Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme.

Publication ,  Journal Article
Hawkins, NM; Wang, D; McMurray, JJV; Pfeffer, MA; Swedberg, K; Granger, CB; Yusuf, S; Pocock, SJ; Ostergren, J; Michelson, EL; Dunn, FG ...
Published in: Eur J Heart Fail
May 2007

BACKGROUND: Bundle branch block (BBB) is a powerful independent predictor of cardiovascular mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). The prognostic implications in HF with preserved systolic function (HF-PSF) are less well understood. METHODS: The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme randomised 7599 patients with symptomatic HF to receive candesartan or placebo. The primary outcome comprised cardiovascular death or HF hospitalisation. The relative risk conveyed by BBB relative to a normal electrocardiogram was examined. RESULTS: The prevalence of BBB was significantly lower in patients with preserved compared with reduced systolic function (CHARM-Preserved 14.4%, Alternative 29.6%, Added 30.5%), p<0.0001. Overall, the adjusted hazard ratio for the primary outcome was 1.48 (95% confidence interval 1.22-1.78), p<0.0001, reflecting increased risk in patients with reduced LVEF (1.72 [1.28-2.31], p=0.0003). The apparently more modest risk among patients with HF-PSF was significant in unadjusted (1.80 [1.37-2.37], p<0.0001) but not adjusted analysis (1.16 [0.88-1.54], p=0.2897). However, no formal statistical difference was observed between the two cohorts, and interpretation is limited by the unknown prevalence of left and right BBB morphologies in each. Comparing BBB presence with absence yielded qualitatively similar results. CONCLUSION: The simple clinical finding of BBB is a powerful independent predictor of worse clinical outcomes in patients with HF and reduced LVEF. It is less frequent, with a more modest predictive effect, in patients with preserved systolic function.

Duke Scholars

Published In

Eur J Heart Fail

DOI

ISSN

1388-9842

Publication Date

May 2007

Volume

9

Issue

5

Start / End Page

510 / 517

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Tetrazoles
  • Survival Analysis
  • Stroke Volume
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Prevalence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hawkins, N. M., Wang, D., McMurray, J. J. V., Pfeffer, M. A., Swedberg, K., Granger, C. B., … CHARM Investigators and Committees. (2007). Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme. Eur J Heart Fail, 9(5), 510–517. https://doi.org/10.1016/j.ejheart.2006.11.006
Hawkins, Nathaniel M., Duolao Wang, John J. V. McMurray, Marc A. Pfeffer, Karl Swedberg, Christopher B. Granger, Salim Yusuf, et al. “Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme.Eur J Heart Fail 9, no. 5 (May 2007): 510–17. https://doi.org/10.1016/j.ejheart.2006.11.006.
Hawkins NM, Wang D, McMurray JJV, Pfeffer MA, Swedberg K, Granger CB, et al. Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme. Eur J Heart Fail. 2007 May;9(5):510–7.
Hawkins, Nathaniel M., et al. “Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme.Eur J Heart Fail, vol. 9, no. 5, May 2007, pp. 510–17. Pubmed, doi:10.1016/j.ejheart.2006.11.006.
Hawkins NM, Wang D, McMurray JJV, Pfeffer MA, Swedberg K, Granger CB, Yusuf S, Pocock SJ, Ostergren J, Michelson EL, Dunn FG, CHARM Investigators and Committees. Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme. Eur J Heart Fail. 2007 May;9(5):510–517.

Published In

Eur J Heart Fail

DOI

ISSN

1388-9842

Publication Date

May 2007

Volume

9

Issue

5

Start / End Page

510 / 517

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Tetrazoles
  • Survival Analysis
  • Stroke Volume
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Prevalence