Tolerability of beta-blockers in elderly patients with chronic heart failure: the COLA II study.
BACKGROUND
Beta-blockers are recommended therapy for patients with chronic heart failure (CHF). However, there remains concern regarding tolerability of these agents in the elderly, which has contributed to the limited uptake of these agents in clinical practice.


OBJECTIVE
We conducted a multi-national, prospective evaluation of tolerability to carvedilol in 1030 CHF patients aged >70 years selected by their treating physician to receive this agent in everyday practice.


RESULTS
NYHA Class II-IV CHF patients were assessed at baseline for key demographic parameters that may predict tolerability, then followed for 6 months after starting carvedilol. Tolerability was defined as being on >or=6.25 mg bd of carvedilol at 6 months having received a total of >or=3 months therapy. Tolerability overall was 80% with age 70-75 years 84.3%, 76-80 years 76.8% and >80 years 76.8%. Mean carvedilol dose achieved was 31.2 mg. In multivariate analysis, advanced age, low diastolic BP, LVEF, obstructive airways disease and presence of diabetes were predictors of tolerability.


CONCLUSIONS
Carvedilol appears to be well tolerated in this elderly CHF patient cohort. Therefore, elderly CHF patients should not be denied treatment with carvedilol because of concerns regarding tolerability.
Krum
Henry
H
NHMRC Centre for Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 3rd Floor, Burnet Tower, AMREP Precinct, Commercial Road, Melbourne Vic 3004, Australia. henry.krum@med.monash.edu.au
Hill
Julie
J
Fruhwald
Friedrich
F
Sharpe
Christine
C
Abraham
Gyorgy
G
Zhu
Jun-Ren
JR
Poy
Carlos
C
Kragten
J A
JA
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002227:Carbazoles / Q000009:adverse effects*; D000077261:Carvedilol; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D011412:Propanolamines / Q000009:adverse effects*; D011446:Prospective Studies
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol