[The effectiveness of carvedilol in heart failure].
BACKGROUND
The third generation beta-blocker (carvedilol) is effective in reduction of hypertension, and of mortality and morbidity as a supplement to conventional drugs of heart failure therapies (diuretics, ACE inhibitors), based on randomized controlled trials and retrospective analysis.


OBJECTIVE
To analyse the efficacy of carvedilol in the treatment of heart failure with special focused on morbidity, mortality endpoints.


METHODS
We assessed the multicenter, randomised, double-blind studies involving more than 150 patients (1995-2005) from MEDLINE database, in which carvedilol was used in the case of moderate to severe heart failure. We also present the results of health-economic publications (2000-2005).


RESULTS
In U.S. Carvedilol Heart Failure Study (n 1096) the mortality declined by 65% (3.2% vs. 7.8%; p <0.001) with carvedilol vs. placebo, while the cardiovascular hospitalization decline was 27% (14.1% vs. 19.6%; p = 0.036) in heart failure (LVEF < or = 5%) applied together with the basic therapy (diuretic and ACE-inhibitor). In the COPERNICUS trial the efficacy of carvedilol was compared to placebo in the case of severe HF patients (LVEF < 25%, n = 2889). The annual mortality risk declined by 35% (19.7% vs. 12.8%, 95% CI 19-48%, p = 0.00013) while the risk of mortality or any risk of hospitalisation by 24% (p = 0.00004) in the active group. The CAPRICORN study (LVEF < or = 0%, n=1959) showed that carvedilol is efficacious in reduction of total (HR: 0.77; 95% CI 0.60-0.98; p = 0.031) and cardiovascular mortality (HR: 0.75; 95% CI 0.58-0.96; p = 0.024) as far as high-risk patients are concerned.


CONCLUSIONS
The effectiveness of carvedilol is certified in reduction of mortality and hospitalization in the treatment of moderate-severe heart-failure as part of the combination therapy. The benefits of use of the drug are well measurable not only on the level of patients but on the suppliers and the financer as well, thanks to the decline of resource utilization.
Kárpáti
Krisztián
K
Egészség-gazdaságtani és Technológiaelemzési Munkacsoport, Közszolgálati Tanszék, Budapest.
Brodszky
Valentin
V
Farsang
Csaba
C
Jermendy
György
G
Vándorfi
Gyozo
G
Zámolyi
Károly
K
Gulácsi
László
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000191:economics / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D000077261:Carvedilol; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015337:Multicenter Studies as Topic; D011412:Propanolamines / Q000191:economics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol