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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Exchange of beta-blockers in heart failure patients. Experiences from the poststudy phase of COMET (the Carvedilol or Metoprolol European Trial)

Di Lenarda, A. (författare)

Remme, W. J. (författare)

Charlesworth, A. (författare)

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Cleland, J. G. (författare)

Lutiger, B. (författare)

Metra, M. (författare)

Komajda, M. (författare)

Torp-Pedersen, C. (författare)

Scherhag, A. (författare)

Swedberg, Karl, 1944 (författare): Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute

Poole-Wilson, P. A. (författare)

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(creator_code:org_t)

2005-05-28
2005
Engelska.
Ingår i: European journal of heart failure. - : Wiley. - 1388-9842. ; 7:4, s. 640-9

Relaterad länk:: https://onlinelibrar...; visa fler...; https://gup.ub.gu.se...; https://doi.org/10.1...; visa färre...

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord


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

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Av författaren/redakt...: Di Lenarda, A.; Remme, W. J.; Charlesworth, A.; Cleland, J. G.; Lutiger, B.; Metra, M.; visa fler...; Komajda, M.; Torp-Pedersen, C ...; Scherhag, A.; Swedberg, Karl, ...; Poole-Wilson, P. ...; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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Av lärosätet: Göteborgs universitet

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