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MORE STUDIES SUPPORT CARVEDILOL FOR HEART FAILURE.

Carvedilol, a beta-blocker that also blocks alpha receptors and has some antioxidant effects, is among the most intriguing potential new therapies for heart failure, although it is not yet approved for this purpose in the U.S. These three randomized, placebo-controlled studies provide further evidence that carvedilol is beneficial for a range of heart failure states.

Each trial involved about 300 patients and assessed the effects of adding carvedilol to standard therapy (including ACE inhibitors) on outcomes including symptoms, exercise tolerance, quality of life, progression of heart failure, and mortality. Carvedilol was associated with a significant increase in left ventricular ejection fraction in all three studies. In addition, the first trial indicated that patients with moderate to severe heart failure had improvements in symptoms and functional class, and a significant decrease in mortality (4.5 vs. 7.6 percent in controls). The second study showed a 48 percent reduction in the clinical progression of mild heart failure, defined as death due to heart failure, hospitalization for heart failure, or a sustained increase in heart failure mediations (11 vs. 21 percent in controls). The third study found that carvedilol was associated with dose-related reductions in mortality and hospitalization rates in patients with mild to moderate, stable chronic heart failure.

Comment: These data provide impressive support for the benefits of adding carvedilol to standard therapy for patients with mild as well as more severe heart failure.

— TH Lee

Published in Journal Watch General Medicine December 31, 1996

Citation(s):

Packer M et al. Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure: the PRECISE trial. Circulation 1996 Dec 1 94 2793-2799.

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Colucci WS et al. Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. Circulation 1996 Dec 1 94 2800-2806.

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Bristow MR et al. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation 1996 Dec 1 94 2807-2816.

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• Medline abstract (Free)