Assuming the worst may not be bad at all. Carvedilol in heart failure treatment.
OBJECTIVE
Carvedilol, a beta-adrenoceptor blocking agent with additional alpha(1)-adrenoceptor blocking properties, has been shown to improve left ventricular function in chronic heart failure (CHF). However, its effect on mortality has recently been the subject of controversial discussion. The aim of this meta-analysis is to review the data on mortality from two large study programs (the US Carvedilol Heart Failure Study and the study by the Australia/New Zealand Heart Failure Research Collaborative Group) on additional carvedilol treatment in CHF standard therapy and to analyse the design and limitations of the individual studies.


RESULTS
For determination of overall, mortality, all patients who died and all patients who were withdrawn for other reasons during the open run-in phase of the studies were assigned to the carvedilol group to create a "worst-case analysis." Meta-analysis of mortality data using the random effects model shows a significantly reduced relative risk of 0.55 x 95%-confidence interval 0.325-0.924; p < 0.05 of death in patients treated with carvedilol compared with patient on standard treatment only.


CONCLUSIONS
Treatment of CHF using carvedilol significantly reduces mortality in patients with CHF, even if the "worst case" is assumed by assigning all deaths in the open run-in phase to carvedilol.
Institute for Clinical Pharmacology, Faculty of Clinical Medicine at Mannheim, Ruprecht Karls University Heidelberg.
B M
BM
Schmidt
C P
CP
Janson
M
M
Wehling
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol