Report in THE LANCET suggests carvedilol as the definitive beta-blocker for CHF
Calls for beta-blockers to be used ’more widely for heart failure in clinical practice.’
The beta-blocker carvedilol offers substantial survival benefit compared with another widely-used beta blocker for the treatment of chronic heart failure, according to the results of a European study reported in this week’s issue of THE LANCET.
Beta blockers reduce death in patients who are also taking diuretics and ACE inhibitors for chronic heart failure (CHF). In the Carvedilol or Metoprolol European Trial (COMET) led by Philip Poole-Wilson from the UK National Heart and Lung Institute in London, around 3,000 people with chronic heart failure received twice-daily doses of carvedilol or metoprolol for about five years.
Carvedilol had a striking effect on reducing mortality compared with metoprolol; average life-expectancy was eight years for patients given carvedilol compared with 6.6 years for patients assigned to metoprolol. 34% of patients given carvedilol died during the five-year study compared with 40% of patients on metoprolol.
Another study in this week’s issue of THE LANCET highlights how carvedilol is effective in improving ventricular function for patients with with heart failure due to coronary artery disease. The investigators comment how a positive response to carvedilol could avoid the need for an invasive coronary revascularisation operation in some patients with heart failure.
In an accompanying Commentary, Henry Dargie from the Western Infirmary, Glasgow, UK concludes: "COMET and CHRISTMAS are very different trials but together they provide further insights into the benefits of beta blockade in heart failure. They are also timely, because although the history of beta- blockers in heart failure is one of sustained revelation and success, their uptake in clinical practice is disappointing…Action is required if the results of clinical research are to be translated into clinical practice."
Keywords : Chronic heart failure Beta-blockers Clinical trials Europe THE LANCET Carvedilol Metoprolol ACE inhibitor Diuretics COMET Life-expectancy
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