[Tolerability and clinical effects of carvedilol in patients over 70 years of age with chronic heart failure due to left ventricular dysfunction].
BACKGROUND
A number of studies showed the improvement in left ventricular (LV) function and clinical outcome that carvedilol produces in patients with severe congestive heart failure (CHF). However, no data are available regarding beta-blocker treatment in older patients with CHF. The purpose of this study was to assess the tolerability and efficacy of carvedilol in patients > 70 years with CHF associated with LV systolic dysfunction.


METHODS
Thirty-seven patients in NYHA functional class III-IV with LV ejection fraction < 45% and a mean age of 76 +/- 6 years were prospectively studied. They received carvedilol which was associated with conventional therapy for CHF (ACE-inhibitors + diuretics + digitalis). The changes over time in clinical and echocardiographic variables (evaluated at baseline and every 6 months) were compared with those of 23 patients treated with the sole conventional therapy.


RESULTS
During a follow-up of 13 +/- 8 months, 5 patients interrupted carvedilol due to side effects (tolerability 87%). Among the 32 remaining patients, 8 died. NYHA functional class improved in the 56% of survivors, LV ejection fraction increased (30 to 42%, p = 0.0002), mitral regurgitation and pulmonary capillary wedge pressure markedly decreased (2.0 to 1.0, p = 0.0001, and 19 to 13 mmHg, p = 0.0004, respectively). None of these variables was changed at the end of follow-up in the control group. Mortality was similar between the carvedilol (25%) and control group (22%).


CONCLUSIONS
In the very elderly patients with LV systolic dysfunction and CHF carvedilol is well tolerated and safe. The addition of this drug to conventional therapy for CHF provides an important improvement in functional class, LV function and hemodynamics.
Cioffi
G
G
Reparto di Cardiologia Casa di Cura Villa Bianca Via Piave, 78 38100 Trento. gcioffi@albaclick.com
Stefenelli
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C
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002227:Carbazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077261:Carvedilol; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D011412:Propanolamines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D002227:Carbazoles; D011412:Propanolamines; D014665:Vasodilator Agents; D000077261:Carvedilol