The development of heart failure in patients with stable angina pectoris

Background: To describe the clinical characteristics of patients with stable angina pectoris who develop heart failure and the events preceding its onset. Methods and results: Of 7665 patients with stable angina in the ACTION trial, which compared long-acting nifedipine to placebo, 207 (2.7%) developed heart failure (HF) during a mean follow-up of 4.9 years. Those who developed HF were significantly (P < 0.05) older, more often had diabetes, had a more extensive history of cardiovascular disease, lower ejection fractions, a higher serum creatinine and glucose, a lower haemoglobin, and were more often on blood pressure lowering drugs. A cardiac event or an intervention (n = 155), a significant non-cardiac infection (n = 19) or poor control of hypertension (n = 12) preceded the development of HF in 186/207 cases (90%). There was no obvious precipitating factor in the remaining 21 patients (10%). Myocardial infarction increased the risk of the development of new HF within one week more than 100-fold. Nifedipine reduced the incidence of HF by 29% (P = 0.015). Conclusions: The development of heart failure is uncommon in patients with stable angina, and even less so in the absence of an obvious precipitating factor.

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