Circulation. 2002;106:2194-2199
Published online before print October 7, 2002, doi: 10.1161/01.CIR.0000035653.72855.BF
Published online before print October 7, 2002, doi: 10.1161/01.CIR.0000035653.72855.BF
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(Circulation. 2002;106:2194.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Carvedilol on the Morbidity of Patients With Severe Chronic Heart Failure
Results of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study
From the College of Physicians and Surgeons, Columbia University (M.P.), New York, NY; Royal Brompton Hospital (A.J.S.C.), London, UK; Stanford University Medical Center (M.B.F.), Stanford, Calif; Universitaets Klinikum Luebeck (H.A.K.), Luebeck, Germany; Monash University (H.K.), Prahran Victoria, Australia; University Hospital (P.M.), Bern, Switzerland; University Health Network and Mt Sinai Hospital (J.L.R.), Toronto, Canada; Silesian School of Medicine (M.T.), Katowice, Poland; Roche Pharmaceuticals (C.S., I.A.-Z.), Basel, Switzerland; GlaxoSmithKline Ltd (T.L.H.), Philadelphia, Pa; and the University of Wisconsin (E.B.R., D.L.D.), Madison.
Correspondence to Dr Milton Packer, Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032. E-mail mp65{at}columbia.edu
Background— ß-Blocking agents improve functional status and reduce morbidity in mild-to-moderate heart failure, but it is not known whether they produce such benefits in severe heart failure.
Methods and Results— We randomly assigned 2289 patients with symptoms of heart failure at rest or on minimal exertion and with an ejection fraction <25% (but not volume-overloaded) to double-blind treatment with either placebo (n=1133) or carvedilol (n=1156) for an average of 10.4 months. Carvedilol reduced the combined risk of death or hospitalization for a cardiovascular reason by 27% (P=0.00002) and the combined risk of death or hospitalization for heart failure by 31% (P=0.000004). Patients in the carvedilol group also spent 27% fewer days in the hospital for any reason (P=0.0005) and 40% fewer days in the hospital for heart failure (P<0.0001). These differences were as a result of both a decrease in the number of hospitalizations and a shorter duration of each admission. More patients felt improved and fewer patients felt worse in the carvedilol group than in the placebo group after 6 months of maintenance therapy (P=0.0009). Carvedilol-treated patients were also less likely than placebo-treated patients to experience a serious adverse event (P=0.002), especially worsening heart failure, sudden death, cardiogenic shock, or ventricular tachycardia.
Conclusion— In euvolemic patients with symptoms at rest or on minimal exertion, the addition of carvedilol to conventional therapy ameliorates the severity of heart failure and reduces the risk of clinical deterioration, hospitalization, and other serious adverse clinical events.
Key Words: heart failure • adrenergic beta-antagonists • carvedilol
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