Carvedilol may be an option for patients initiating beta-blocker treatment for heart failure or patients in whom metoprolol is poorly tolerated. We present the results of the COMET trial and other research and discuss strategies for initiating carvedilol treatment. Gout - Hit the target A slow death from colchicine Is carvedilol superior to metoprolol in heart failure? The body releases these hormones as part of its response to heart failure. For this and other reasons, beta-blockers have been shown to be effective for treating most people who have heart failure. Beta-blockers have a variety of effects throughout the body. They are used to treat heart disease that causes chest pain, high blood pressure, Beta-blockers can slow the progression of systolic forms of heart failure. Beta-blockers may be used to treat left ventricular systolic dysfunction in people who are stable and have no symptoms or only mild to moderate heart failure symptoms. Beta-blockers may be used together with other medicines that are usually used to treat heart failure, such as angiotensin-converting enzyme (ACE) inhibitors or diuretics. Beta-blockers may be used to treat diastolic heart failure too.
If you have heart failure, you need beta-blockers -- even if you do not have symptoms. Beta-blockers are prescribed for patients with systolic heart failure and improve survival, even in people with severe symptoms. There are several types of beta-blockers, but only three are approved by the FDA to treat heart failure: They may be taken with meals, at bedtime, or in the morning. Food delays how your body absorbs beta-blockers, but they also may reduce side effects. Beta-blockers shouldn’t be used if you have very low blood pressure (hypotension) or a slow pulse (bradycardia) that may cause you to feel dizzy or lightheaded. If you have severe lung congestion, your doctor will treat your congestion before prescribing a beta-blocker. While you are taking this beta-blocker, your doctor may tell you to take and record your pulse daily. If your pulse is slower than it should be or your blood pressure is less than 100, call your doctor about taking your beta-blocker that day. Never stop taking your medicine without speaking to your doctor first, even if you feel that it’s not working. However, it had several methodologic problems: it was a composite of 4 smaller studies that used exercise tolerance as the primary endpoint; median duration of data collection on subjects was only 6 months; it included many minimally symptomatic patients; the actual number of deaths was small (producing a wide confidence interval); and subjects who did not survive the run-in phase were excluded from analysis. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. The US Carvedilol trial demonstrated a larger reduction in mortality than that seen in other beta-blocker trials. We found no meta-analysis that pooled data on individual drugs for comparison purposes. This suggests there may be differences in effectiveness among beta-blockers in reducing mortality in heart failure, and that it would be unwise to assume that protection is a class effect. The Carvedilol Prospective Randomized Cumulative Survival (BEST) demonstrated no effect with bucindolol. Effect of carvedilol on survival in severe chronic heart failure. Effect of metoprolol CR/XL in chronic heart failure: Metotprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. In all trials, the majority of subjects were taking diuretics and either an ACE inhibitor or angiotensin receptor blocker. Influence of beta-blockers on mortality in chronic heart failure. Metra M, Giubbini Raffaele, Nodari E, Boldi E, Modena MG, Dei Cas L. Rationale and design of the carvedilol or metoprolol European trail in patients with chronic heart failure: COMET. The Table shows the 5 largest trials of beta-blockers in systolic dysfunction, including patients with both ischemic and nonischemic heart disease.
Beta blocker therapy is indicated in all patients with heart failure with reduced ejection fraction (HFr EF) as per current guidelines. The relative benefit of carvedilol to metoprolol succinate remains unknown. This study aimed to compare survival benefit of carvedilol to metoprolol succinate. The VA’s databases were queried to identify 114,745 patients diagnosed with HFr EF from 2007 to 2015 who were prescribed carvedilol and metoprolol succinate. The study estimated the survival probability and hazard ratio by comparing the carvedilol and metoprolol patients using propensity score matching with replacement techniques on observed covariates. Sub-group analyses were performed separately for men, women, elderly, duration of therapy of more than 3 months, and diabetic patients. A total of 43,941 metoprolol patients were matched with as many carvedilol patients. Beta-blockers were traditionally thought to be contraindicated in heart failure due to their negative inotropic properties. However, recent research has revealed the beneficial effects of treating heart failure patients with beta-blockers. Heart failure is a clinical condition in which the heart is unable to pump sufficient blood around the body to meet its metabolic needs. It is characterised by abnormalities of left ventricular function and neurohormonal regulation, exercise intolerance, shortness of breath, fluid retention and reduced longevity. Heart failure can be due to systolic or diastolic left ventricular dysfunction. Most patients with heart failure have primarily systolic dysfunction. In two-thirds of patients with systolic dysfunction, the cause is coronary artery disease.2 However, patients may also have nonischaemic causes of cardiomyopathy such as hypertension, valvular heart disease, myocarditis, systemic disease, toxins, alcohol/drug abuse, or idiopathic cardiomyopathy.
EVIDENCE-BASED ANSWER. Three beta-blockers—carvedilol, metoprolol, and bisoprolol—reduce mortality in chronic heart failure caused by left ventricular. Beta-blockers were traditionally thought to be contraindicated in heart failure. Examples of second-generation beta-blockers are metoprolol and bisoprolol.