title: Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure.
abstract: The use of beta-blockers for the treatment of heart failure in the United States is inadequate, despite available data and current guidelines that support their use. The Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) study was designed to determine whether initiation of beta-blockade before hospital discharge is safe and effective in improving the 60-day use of beta-blockers in patients with heart failure. IMPACT-HF compared the strategy of the initiation of carvedilol before patients were discharged versus usual care (Heart Failure Society of America guidelines recommend waiting 2 to 4 weeks after hospitalization for heart failure before initiating beta-blocker therapy) in 363 randomized patients with heart failure. The entry criteria were non-restrictive to ensure inclusion of patients reflective of the general heart failure population. The primary end point of the study (the number of patients treated with any beta-blocker at 60 days) was statistically significantly higher in the predischarge group versus the postdischarge group (91.2% vs 73.4%, respectively). Based on the study's results, predischarge initiation may be a successful strategy to improve the use of beta-blocker therapy for patients with heart failure.
authors.affiliation: Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina 27705, USA. wendy.gattis@duke.edu
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Gattis
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018579:Patient Selection; D011412:Propanolamines / Q000627:therapeutic use*; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol