August 23, 2007European Journal of Heart Failure
Effect of Carvedilol and Metoprolol on the Mode of Death in Patients with Heart Failure
Why the study?
Does carvedilol reduce specific modes of death compared to metoprolol tartrate in patients with NYHA II-IV heart failure and EF <35%?
Population
3029 patients with NYHA II-IV heart failure and EF <35%
Comparison
Carvedilol vs Metoprolol tartrate
Design
RCT
Follow-up
average 58 months
Authors
Discussion
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Member takes
Implication
Supports carvedilol over metoprolol tartrate in HFrEF; extends evidence for agent-specific beta-blocker effects on mortality.
Key Points
- To determine whether the survival advantage of carvedilol compared with metoprolol tartrate in patients with heart failure is driven by reductions in specific modes of death.
- Analyzed 1112 deaths (972 cardiovascular: 480 sudden, 365 circulatory failure, 51 stroke) among 3029 patients with NYHA class II–IV heart failure and ejection fraction <35% followed for an average of 58 months.
- Evaluated the effect of treatment allocation and pre-specified baseline characteristics on each mode of death using multivariate Cox proportional hazards regression and competing risk analyses.
- Compared with metoprolol, carvedilol significantly decreased cardiovascular death (RR 0.80, 95% CI 0.70–0.91, p=0.0009), sudden death (RR 0.77, 95% CI 0.64–0.93, p=0.0073), and stroke death (RR 0.37, 95% CI 0.19–0.71, p=0.0027).
- Circulatory failure death showed a non-significant reduction with carvedilol (RR 0.83, 95% CI 0.66–1.04, p=0.07), while stroke death reduction was significantly greater than circulatory failure death reduction in competing risk analysis (p=0.0071).
Structured PICO
Does carvedilol reduce specific modes of death compared to metoprolol tartrate in patients with NYHA II-IV heart failure and EF <35%?
P
Population
3029 patients with NYHA II-IV heart failure and EF <35%
I
Intervention
Carvedilol
C
Comparator
Metoprolol tartrate
O
Outcome
Mode of death (cardiovascular, sudden, circulatory failure, and stroke deaths)hard clinical
Carvedilol provides a relatively non-specific mortality reduction across various modes of cardiovascular death compared to metoprolol tartrate in patients with heart failure, with a particularly pronounced reduction in stroke deaths.
Cite This Study
Remme et al. (2007) studied this question.