How many patients with heart failure are suitable for combination ACE inhibitor and candesartan therapy?

Background: Adding candesartan to ACE inhibitor therapy significantly reduced cardiovascular deaths and heart failure (HF) hospitalisations in the CHARM-Added trial. Many clinicians have not adopted this approach due to concerns that real-life patients differ from trials and are at greater risk of adverse events, particularly hyperkalaemia.<p></p> Methods: All referrals to the HF service of a large urban hospital in 2007 were included. Information was collected retrospectively from electronic patient records. We examined how many patients fulfilled CHARM-Added inclusion criteria and had predictors of hyperkalaemia, identified by analysis of that biochemical abnormality in the trial. <p></p> Results: Of 409 referrals, 194 fulfilled CHARM-Added enrolment criteria. With the exception of age, their characteristics and treatments were comparable to participants in CHARM-Added (Table). Predictors of hyperkalaemia were common (72% overall). Raised potassium (13%) and creatinine (7%) were similar to CHARM but advanced age (45%) and spironolactone use (30%) were notably more frequent.<p></p&gt