Packer et al1 have reported the results from the US Carvedilol Heart Failure Study that enrolled 1094 patients with chronic heart failure in a double-blind, placebo-controlled, stratified program in which patients were assigned to one of four treatment protocols on the basis of their exercise capacity. In each of the four protocols, patients with mild, moderate, or severe heart failure with left ventricular ejection fractions ≤0.35 were randomly assigned to receive either placebo (n=398) or the β-blocker carvedilol (n=696). These patients received digoxin, diuretics, and an angiotensin-converting enzyme inhibitor at constant doses. Patients were observed for the development of hospitalization for cardiovascular reasons or death during the following 6 months and 12 months for the patients with mild heart failure.
The mortality rate was 7.8% in the placebo group and 3.2% in the carvedilol group. These data led the Data and Safety Monitoring Board to recommend termination of the study before its scheduled completion. Carvedilol therapy was also associated with a 27% reduction in the risk of hospitalization for cardiovascular causes (19.6% versus 14.1%, P=.036) and a 38% reduction in the combined risk of hospitalization or death (24.6% versus 15.8%, P<.001). Worsening heart failure as an adverse reaction during treatment was less frequent in the carvedilol group than in those patients receiving placebo.
Thus, these data suggest that carvedilol, an α1- and β2-blocker of adrenergic receptors, reduces the risk of death and the need for hospitalization for cardiovascular causes in patients with heart failure who are receiving treatment with diuretics, digoxin, and angiotensin-converting enzyme inhibitors.
- Copyright © 1996 by American Heart Association
Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusteman NH. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure: US Carvedilol Heart Failure Study Group (see comments). N Engl J Med.. 1996;334:1349-1355. Comment. 1996;334:1396-1397.