title: Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: an analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).
abstract: BACKGROUND
  The IMPACT-HF trial demonstrated that carvedilol use at the time of heart failure (HF) hospital discharge significantly increased 90-day postdischarge treatment rates. Whether there is an early survival benefit associated with this therapeutic approach in patients hospitalized for HF is unknown. We examined the early effects on mortality and rehospitalization of carvedilol use at discharge in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) compared with outcomes in patients who are eligible for, but do not receive, beta blockers before discharge.
  
  
  METHODS
  The OPTIMIZE-HF program enrolled 5791 patients admitted with HF in a web-based registry at 91 hospitals participating with prespecified 60- to 90-day follow-up from March 2003 to December 2004. Outcomes data were prospectively collected on patients eligible for beta-blocker therapy and analyzed according to predischarge beta-blocker use.
  
  
  RESULTS
  The mean age was 69.7 years; 63% were male, etiology was ischemic in 52%, and mean left ventricular ejection fraction was 24.3%. A total of 2720 patients had LVSD, among whom 2373 (87.2%) were eligible to receive a beta blocker at discharge and carvedilol was prescribed in 1162 (49.0%). Discharge use of carvedilol was associated with a significant reduction in mortality risk at 60 to 90 days (hazard ratio 0.46, P = .0006) and mortality or rehospitalization (odds ratio 0.71, P = .0175) compared to no predischarge beta blocker. Predischarge use of carvedilol was well tolerated with high rates of continued therapy at 60 to 90 days follow-up. Similar findings were observed for other evidence-based beta blockers.
  
  
  CONCLUSIONS
  Carvedilol use at the time of HF hospital discharge is well tolerated, improves treatment rates, and is associated with an early survival benefit. These findings provide further support for guideline recommendations that carvedilol or other evidence-based beta blocker should be initiated before hospital discharge in stable patients with HF and LVSD.
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Barry H
authors.initials: BH
authors.lastname: Greenberg
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Jie Lena
authors.initials: JL
authors.lastname: Sun
authors.forename: Clyde
authors.initials: C
authors.lastname: Yancy
authors.forename: James B
authors.initials: JB
authors.lastname: Young
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011412:Propanolamines / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol