Treatment of chronic heart failure with carvedilol in daily practice: the SATELLITE survey experience.
BACKGROUND
Beta-blockers are well established for treatment of chronic heart failure (CHF). However, the extent of implementation of trial results and guidelines in daily practice remains limited, and information regarding how patients feel is scarce.


METHODS
In this prospective observational survey of 6 months duration, 531 physicians from 10 countries recruited 3748 beta-blockers untreated patients with CHF. We assessed the efficacy, tolerability and achieved dosage of carvedilol. In addition, patients assessed their well-being 3 times: at baseline, after 3 and 6 months of treatment.


RESULTS
Carvedilol was started in 3721 patients with CHF (median age 65 years, 60% men). NYHA class, clinical symptoms and signs, vital signs, 5-item well-being rating scale and visual analogue scale improved during the survey. Side effects, mostly fatigue, hypotension, and dizziness, were reported for 6.5% and 5% of patients at 3 and 6 months and carvedilol had to be discontinued in 63 patients. A total of 55 deaths (1.5%) and 520 hospitalisations in 466 patients (13%) were recorded. At 6 months the mean daily dose of carvedilol was 31+/-11 mg; 25 mg/day was prescribed to 35% and 50 mg/day to 26% of patients.


CONCLUSIONS
Initiation and up-titration of carvedilol in ambulatory care patients with CHF is feasible and safe. Its efficacy and tolerability were at least as good as in clinical trials, while the amelioration of patients' well-being was significant despite sub-optimal dosing. An additional effort should be done by physicians to treat their patients with CHF in daily practice with the recommended beta-blockers at optimal doses.
Lainscak
Mitja
M
Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia. mitja.lainscak@guest.arnes.si
Moullet
Christine
C
Schön
Norbert
N
Tendera
Michal
M
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000453:epidemiology; D000077261:Carvedilol; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies