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Exchange of beta-bl...
Exchange of beta-blockers in heart failure patients. Experiences from the poststudy phase of COMET (the Carvedilol or Metoprolol European Trial)
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Di Lenarda, A. (author)
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Remme, W. J. (author)
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Charlesworth, A. (author)
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Cleland, J. G. (author)
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Lutiger, B. (author)
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Metra, M. (author)
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Komajda, M. (author)
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Torp-Pedersen, C. (author)
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Scherhag, A. (author)
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- Swedberg, Karl, 1944 (author)
- Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute
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Poole-Wilson, P. A. (author)
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(creator_code:org_t)
- 2005-05-28
- 2005
- English.
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In: European journal of heart failure. - : Wiley. - 1388-9842. ; 7:4, s. 640-9
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- dosage/pharmacology/*therapeutic use
- Aged
- Blood Pressure/drug effects
- Carbazoles/administration & dosage/pharmacology/*therapeutic use
- Female
- Heart Failure
- Congestive/*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
- Treatment Outcome
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Di Lenarda, A.
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Remme, W. J.
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Charlesworth, A.
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Cleland, J. G.
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Lutiger, B.
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Metra, M.
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show more...
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Komajda, M.
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Torp-Pedersen, C ...
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Scherhag, A.
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Swedberg, Karl, ...
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Poole-Wilson, P. ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European journal ...
- By the university
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University of Gothenburg