Affiliation:
1. the Boston University School of Medicine, Boston, Mass (W.S.C.); the College of Physicians and Surgeons, Columbia University, New York, NY (M.P., J.D.S.-B.); University of Colorado Health Sciences Center, Denver (M.R.B.); University of Utah School of Medicine, Salt Lake City (E.M.G.); University of Minnesota Medical School, Minneapolis (J.N.C.); Stanford University School of Medicine, Palo Alto, Calif (M.B.F.); Nebraska Heart Institute, Lincoln (S.K.K.); University of Oregon School of Medicine,...
Abstract
Background
We tested the hypothesis that carvedilol inhibits clinical progression in patients with mildly symptomatic heart failure due to left ventricular (LV) systolic dysfunction.
Methods and Results
Patients (n=366) who had mildly symptomatic heart failure with an LV ejection fraction (LVEF) ≤0.35, had minimal functional impairment (defined as the ability to walk 450 to 550 m on a 6-minute walk test), and were receiving optimal standard therapy, including ACE inhibitors, were randomized double-blind to carvedilol (n=232) or placebo (n=134) and followed up for 12 months. The primary end point was clinical progression, defined as death due to heart failure, hospitalization for heart failure, or a sustained increase in heart failure medications. Clinical progression of heart failure occurred in 21% of placebo patients and 11% of carvedilol patients, reflecting a 48% (
P
=.008) reduction in the primary end point of heart failure progression (relative risk, 0.52; CI, 0.32 to 0.85). This effect of carvedilol was not influenced by sex, age, race, cause of heart failure, or baseline LVEF. Carvedilol also significantly improved several secondary end points, including LVEF, heart failure score, NYHA functional class, and the physician and patient global assessments. Carvedilol reduced all-cause mortality but had no effects on the Minnesota Living With Heart Failure scale, the distance walked in 9 minutes on a self-powered treadmill, or cardiothoracic index. The drug was well tolerated.
Conclusions
Carvedilol, when added to standard therapy, including an ACE inhibitor, reduces clinical progression in patients who are only mildly symptomatic with well-compensated heart failure.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
522 articles.
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