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The Definitive Beta-blocker For Heart Failure? (pp 2, 7, 14)
July 02, 2003Results of a European study in this week's issue of THE LANCET suggest that the beta-blocker carvedilol offers substantial survival benefit compared with another widely-used beta blocker for the treatment of chronic heart failure.
Beta blockers reduce death in patients who are also taking diuretics and ACE inhibitors for chronic heart failure. In the Carvedilol or Metoprolol European Trial (COMET) led by Philip Poole-Wilson from the UK National Heart and Lung Institute, around 3000 people with chronic heart failure were assigned to receive twice-daily doses of carvedilol or metoprolol for around five years.
Carvedilol had a striking effect on reducing mortality compared with metoprolol; average life-expectancy was eight years for patients given carvedilol compared with 6.6 years for patients assigned metoprolol. 34% of patients assigned carvedilol died during the five-year study compared with 40% of patients assigned metoprolol.
Another study in this week's issue of THE LANCET (p 14) highlights how carvedilol is effective in improving ventricular function for patients with with heart failure due to coronary artery disease. The investigators comment how a positive response to carvedilol could obviate the need for invasive coronary revascularisation in some patients with heart failure.
Inn an accompanying Commentary (p 2), Henry Dargie from the Western Infirmary, Glasgow, UK concludes: "COMET and CHRISTMAS are very different trials but together they provide further insights into the benefits of beta blockade in heart failure. They are also timely, because although the history of beta blockers in heart failure is one of sustained revelation and success, their uptake in clinical practice is disappointingAction is required if the results of clinical research are to be translated into clinical practice."
Lancet
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