A description of the clinical characteristics at baseline of patients recruited into the Carvedilol or Metoprolol European Trial (COMET).
OBJECTIVE
The COMET trial was a prospective, double-blind, randomised trial comparing carvedilol, a comprehensive adrenergic receptor antagonist, with metoprolol, a beta-1-selective agent in patients with heart failure and left ventricular systolic dysfunction. The trial showed a reduction in mortality with carvedilol that was consistent across subgroups. The purpose of this report is to describe in greater detail the heterogeneity of this population at baseline with particular reference to the impact of symptomatic severity, age and gender on patient characteristics.


METHODS
A descriptive report using data entered in the COMET study data-base.


RESULTS
The characteristics of the population studied were similar to those reported in previous trials of beta-blockers. Almost all patients were receiving diuretics and ACE inhibitors with few patients taking angiotensin receptor blockers. As expected, older patients had more co-morbidity. Older patients and women reported worse symptoms and poorer well-being despite similar ventricular dimensions and systolic dysfunction. NT-proBNP was higher in patients with more severe symptoms and older patients but not in women, although differences in NT-proBNP may have been confounded by differences in renal function.


CONCLUSIONS
Age and gender, as well as the severity of cardiac dysfunction, appear to have an important effect on the severity of heart failure symptoms and patient 'well-being'. This could have important implications for the relationship between symptoms and prognosis and therefore the way in which patients are selected for clinical trials and the goals of treatment. This will be the subject of further analyses.
Cleland
John G F
JG
University of Hull, Kingston upon Hull, UK. g.m.porter@hull.ac.uk
Goode
Kevin
K
Erhardt
Leif
L
Remme
Willem J
WJ
Charlesworth
Andrew
A
Poole-Wilson
Philip A
PA
Di Lenarda
Andrea
A
Hanrath
Peter
P
Komajda
Michel
M
Metra
Marco
M
Swedberg
Karl
K
Torp-Pedersen
Christian
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D011412:Propanolamines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012737:Sex Factors
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol