EFFECT OF ENALAPRIL, HYDRALAZINE PLUS ISOSORBIDE DINITRATE, AND PRAZOSIN ON HOSPITALIZATION IN PATIENTS WITH CHRONIC CONGESTIVE-HEART-FAILURE

Background. Hospitalization of persons with congestive heart failure f or recurrent heart failure or other complications is common. Methods a nd Results. Male patients aged 18-75 with chronic heart failure were r andomized in two sequential trials designed to study the efficacy of v asodilator therapy. Patients were evaluated every 3 months, and inform ation regarding hospitalizations between visits was obtained from the patient, his family, and/or hospital records. Hospitalization data als o were obtained for patients who had died between scheduled clinic vis its. Hospitalizations were not recorded if a patient died during trans it to the hospital or in the hospital emergency department before admi ssion. In Vasodilator-Heart Failure Trial (V-HeFT) I, no significant d ifference in number of patients hospitalized or number of hospitalizat ions was noted among the treatment groups, although there was a trend for fewer and delayed cardiac hospitalizations in the hydralazine plus isosorbide dinitrate arm in which the survival was greater. In V-HeFT II, no difference in hospitalizations was apparent between the enalap ril and hydralazine plus isosorbide dinitrate arms. Univariate predict ors of hospitalization for all causes were reduced peak oxygen consump tion (VO2) during exercise (p<0.0001), reduced exercise duration (p<0. 0001), increased cardiothoracic ratio on chest radiograph (p<0.0001), increased age (p<0.03), and use of antiarrhythmic drugs (p<0.013), whe reas multivariate predictors were reduced peak VO2 (p<0.0001), use of antiarrhythmic drugs (p<0.015), and increased cardiothoracic ratio (p< 0.03). Univariate predictors of hospitalization for heart failure were peak VO2 (P<0.0001), LVEF (p<0.0001), reduced exercise duration (p<0. 0001), elevated cardiothoracic ratio (p<0.0001), and elevated plasma n orepinephrine (p<0.0001). Multivariate predictors were exercise durati on (p<0.0001), LVEF (p<0.04), elevated cardiothoracic ratio (p<0.03), plasma norepinephrine (p<0.0005), and coronary artery disease (p<0.02) . Time to first hospitalization, cause specific or overall, was consid erably shorter for patients with baseline peak VO2<10 mL . kg-1 - min- 1 compared with those with peak VO2>15 mL - kg-1 . min-1. Conclusions. Despite better survival in patients randomized to hydralazine plus is osorbide dinitrate compared with placebo and better survival in patien ts randomized to enalapril compared with hydralazine plus isosorbide d initrate, no significant differences between the treatment groups were apparent in the incidence of hospitalization or time to first hospita lization for congestive heart failure, for cardiac reasons other than congestive heart failure, or for other causes. V-HeFT I and V-HeFT II data demonstrate no treatment effect on hospitalization, perhaps refle cting in part the effectiveness of the Veterans Affairs special heart failure clinics in dealing with worsening heart failure on an outpatie nt basis. Identification of predictors of hospitalization were similar in both studies.