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Carvedilol Beneficial for Class IV CHF Patients

Carvedilol and other beta-blockers are usually considered to be contraindicated for patients with class IV congestive heart failure (CHF) due to the high risk for short-term complications, but some data suggest these patients may be the ones most likely to benefit. This Australian study analyzed outcomes for 230 patients treated with carvedilol for heart failure, including 63 who were designated class IV.

Carvedilol was tolerated long-term by 71 percent of class IV patients; 59 percent improved by at least one functional class, versus 37 percent of less symptomatic patients. Serious, nonfatal adverse events occurred in 43 percent of class IV patients, versus 24 percent of less symptomatic patients. The most common problem was worsening heart failure (22 percent vs. 10 percent). Class IV patients most likely to have adverse events had lower systolic blood pressures and lower serum sodium levels. Most adverse events occurred within six weeks of starting carvedilol, with more than half occurring within two weeks, when patients were on the lowest doses.

Comment: These data show that carvedilol is more likely to cause complications among class IV patients with CHF than among less symptomatic patients, but class IV patients are more likely to improve with this therapy. These findings argue for consideration of beta-blocker therapy for patients with advanced CHF -- but with great caution and close follow-up.

— TH Lee

Published in Journal Watch General Medicine March 30, 1999

Citation(s):

Macdonald PS et al. Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure. J Am Coll Cardiol 1999 Mar 15 33 924-931.

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