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Effects of controll...
Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure. The Metoprolol CR/XL randomized intervention trial in congestive heart failure
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Hjamarson, A (author)
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Goldstein, S (author)
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Fagerberg, B (author)
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Wedel, H (author)
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Waagstein, F (author)
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Kjekshus, J (author)
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Wikstrand, J (author)
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El Allaf, D (author)
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Vitovec, J (author)
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Aldershvile, J (author)
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Halinen, M (author)
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Dietz, R (author)
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Neuhaus, KL (author)
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Janosi, A (author)
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Thorgeirsson, G (author)
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Dunselman, PH (author)
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Gullestad, L (author)
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Kuch, J (author)
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- Herlitz, J (author)
- [external]
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Rickenbacher, P (author)
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Ball, S (author)
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Gottlieb, S (author)
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Deedvania, P (author)
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(creator_code:org_t)
- JAMA, 2000
- 2000
- Swedish.
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In: Journal of the American Medical Association. - : JAMA. - 0221-7678. ; 283:10, s. 1295-1302
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https://jamanetwork....
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https://doi.org/10.1...
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Abstract
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- Results from recent studies on the effects of beta1-blockade in patients with heart failure demonstrated a 34% reduction in total mortality. However, the effect of beta1-blockade on the frequency of hospitalizations, symptoms, and quality of life in patients with heart failure has not been fully explored. OBJECTIVE: To examine the effects of the beta1-blocker controlled-release/extended-release metoprolol succinate (metoprolol CR/XL) on mortality, hospitalization, symptoms, and quality of life in patients with heart failure. DESIGN: Randomized, double-blind controlled trial, preceded by a 2-week single-blind placebo run-in period, conducted from February 14, 1997, to October 31, 1998, with a mean follow-up of 1 year. SETTING: Three hundred thirteen sites in 14 countries. PARTICIPANTS: Patients (n = 3991) with chronic heart failure, New York Heart Association (NYHA) functional class II to IV, and ejection fraction of 0.40 or less who were stabilized with optimum standard therapy. INTERVENTIONS: Patients were randomized to metoprolol CR/XL, 25 mg once per day (NYHA class II), or 12.5 mg once per day (NYHA class III or IV), titrated for 6 to 8 weeks up to a target dosage of 200 mg once per day (n = 1990); or matching placebo (n = 2001). MAIN OUTCOME MEASURES: Total mortality or any hospitalization (time to first event), number of hospitalizations for worsening heart failure, and change in NYHA class, by intervention group; quality of life was assessed in a substudy of 741 patients. RESULTS: The incidence of all predefined end points was lower in the metoprolol CR/XL group than in the placebo group, including total mortality or all-cause hospitalizations (the prespecified second primary end point; 641 vs 767 events; risk reduction, 19%; 95% confidence interval [CI], 10%-27%; P<.001); total mortality or hospitalizations due to worsening heart failure (311 vs 439 events; risk reduction, 31%; 95% CI, 20%-40%; P<.001), number of hospitalizations due to worsening heart failure (317 vs 451; P<.001); and number of days in hospital due to worsening heart failure (3401 vs 5303 days; P<.001). NYHA functional class, assessed by physicians, and McMaster Overall Treatment Evaluation score, assessed by patients, both improved in the metoprolol CR/XL group compared with the placebo group (P = .003 and P = .009, respectively). CONCLUSIONS: In this study of patients with symptomatic heartfailure, metoprolol CR/XL improved survival, reduced the need for hospitalizations due to worsening heart failure, improved NYHA functional class, and had beneficial effects on patient well-being.
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- art (subject category)
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- By the author/editor
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Hjamarson, A
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Goldstein, S
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Fagerberg, B
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Wedel, H
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Waagstein, F
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Kjekshus, J
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show more...
-
Wikstrand, J
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El Allaf, D
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Vitovec, J
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Aldershvile, J
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Halinen, M
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Dietz, R
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Neuhaus, KL
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Janosi, A
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Thorgeirsson, G
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Dunselman, PH
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Gullestad, L
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Kuch, J
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Herlitz, J
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Rickenbacher, P
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Ball, S
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Gottlieb, S
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Deedvania, P
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show less...
- Articles in the publication
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Journal of the A ...
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JAMA
- By the university
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University of Borås