Document Detail


Exchange of beta-blockers in heart failure patients. Experiences from the poststudy phase of COMET (the Carvedilol or Metoprolol European Trial).
MedLine Citation:
PMID:  15921806     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Carvedilol or Metoprolol European Trial (COMET) reported a significant survival benefit for carvedilol, a beta1-, beta2- and alpha1-blocker, vs. metoprolol tartrate, a beta1-selective blocker, in patients with mild-to-severe chronic heart failure (CHF). Patients on treatment with metoprolol might benefit from switching to carvedilol.
AIM: To investigate the safety and tolerability of switching beta-blockers in CHF.
METHODS: At the end of COMET, the Steering Committee recommended that study medication was stopped without unblinding, and patients were commenced on open-label beta-blockade at a dose equivalent to half the dose of blinded therapy, with subsequent titration to target or maximum tolerated dose. Patients were followed for 30 days.
RESULTS: 1321 out of 1440 patients were transitioned to open-label treatment (76.8% to carvedilol). Serious adverse and CHF-related events were respectively 9.4% and 4.7% in those switching from carvedilol to metoprolol and 3.1% and 1.5% in patients switching from metoprolol to carvedilol. Patients who switched from carvedilol to metoprolol showed the highest mortality or hospitalisation rate (12.3%) in comparison with those who switched from metoprolol to carvedilol (3.1%, p<0.001) or who stayed on the same drug (carvedilol: 2.5%, p<0.001; metoprolol: 4.2%, p=0.04). Reducing the initial dose of the second beta-blocker maximised the safety of this strategy. Event rate was higher in patients with more severe heart failure and in those withdrawing from beta-blockade.
CONCLUSION: Our data show that switching beta-blockers is a practical, safe and well-tolerated strategy to optimise treatment of CHF. Patients who switched to carvedilol showed the lowest rate of adverse events. A closer clinical monitoring is recommended during transition in high-risk patients.
Authors:
Andrea Di Lenarda; Willem J Remme; Andrew Charlesworth; John G F Cleland; Beatrix Lutiger; Marco Metra; Michel Komajda; Christian Torp-Pedersen; Armin Scherhag; Karl Swedberg; Philip A Poole-Wilson;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of heart failure     Volume:  7     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-05-30     Completed Date:  2005-09-27     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  640-9     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Ospedale di Cattinara, Strada di Fiume 447, 34100 Trieste, Italy. dilenar@univ.ts.it
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage,  pharmacology,  therapeutic use*
Aged
Blood Pressure / drug effects
Carbazoles / administration & dosage,  pharmacology,  therapeutic use*
Female
Heart Failure / drug therapy*
Heart Rate / drug effects
Humans
Male
Metoprolol / administration & dosage,  pharmacology,  therapeutic use*
Middle Aged
Propanolamines / administration & dosage,  pharmacology,  therapeutic use*
Randomized Controlled Trials as Topic
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 37350-58-6/Metoprolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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