title: Tolerability, safety, and efficacy of beta-blockade in black patients with heart failure in the community setting: insights from a large prospective beta-blocker registry.
abstract: Heart failure (HF) clinical trials suggest different responses of blacks and whites to beta-blockers. Differences between clinical trial and community settings may also have an impact. The Carvedilol Heart Failure Registry (COHERE) observed experience with carvedilol in 4280 patients with HF in a community setting. This analysis compares characteristics, outcomes, and carvedilol dosing of blacks and whites in COHERE. Compared with whites (n=3433), blacks (n=523) had more severe HF symptoms despite similar systolic function. At similar carvedilol maintenance doses, symptoms improved in 33% of blacks vs 28% of whites, while worsening in 10% and 11%, respectively (both nonsignificant), and HF hospitalization rates were reduced comparably in both groups (-58% vs -56%, respectively; both P<.001). Incidence and hazard ratios of death were similar in blacks and whites (6.9% vs 7.5%, hazard ratio 1.2 vs 1.0, P=.276). Thus carvedilol was similarly effective in blacks and whites with HF in the community setting, consistent with carvedilol clinical trials.
authors.affiliation: Division of Cardiovascular Medicine, The Ohio State University School of Medicine, Columbus, OH, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Lukas
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Lottes
authors.forename: Jeanenne J
authors.initials: JJ
authors.lastname: Nelson
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fowler
authors.forename: Barry
authors.initials: B
authors.lastname: Greenberg
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Franciosa
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001741:Black or African American; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008297:Male; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol