EFFECT OF AMLODIPINE ON MODE OF DEATH AMONG PATIENTS WITH ADVANCED HEART-FAILURE IN THE PRAISE TRIAL

Investigations of calcium antagonists in patients with advanced heart failure have raised concern over an increased risk of worsening heart failure and heart failure deaths. We assessed the effect of amlodipine on cause-specific mortality in such patients enrolled in a randomized , double-blind, placebo-controlled trial. In total, 1,153 patients in New York Heart Association class IIIb or IV heart failure were randomi zed to receive amlodipine or placebo, along with angiotensin-convertin g enzyme inhibitors, diuretics, and digitalis. Over a median 14.5 mont hs of follow-up, 413 patients died. Cardiovascular deaths accounted fo r 89% of fatalities, 50% of which were sudden deaths and 45% of which were due to pump failure, with fewer attributed to myocardial infarcti on (3.3%) or other cardiovascular causes (1.6%). Amlodipine treatment resulted in a greater relative reduction in sudden deaths (21%) than I n pump failure deaths (6.6%) overall. When patients were classified by etiology of heart failure (ischemic or nonischemic), cause-specific m ortality did not differ significantly between treatment groups in the ischemic stratum. In the nonischemic stratum, however, sudden deaths a nd pump failure deaths were reduced by 38% and 45%, respectively, with amlodipine. Thus, when added to digitalis, diuretics, and angiotensin -converting enzyme inhibitors in patients with advanced heart failure, amlodipine appears to have no effect on cause-specific mortality in i schemic cardiomyopathy, but both pump failure and sudden deaths appear to be decreased in nonischemic heart failure patients treated with am lodipine. (C)1998 by Excerpta Medica, Inc.