Carvedilol versus controlled-release metoprolol for elderly veterans with heart failure.
OBJECTIVE
To characterize prescribing of carvedilol and controlled-release (CR) metoprolol for veterans with heart failure who were predominantly elderly (aged > or = 65) and to compare the time to first hospitalization or death.


METHODS
Retrospective cohort.


METHODS
Veterans Health Administration (VHA) nationwide healthcare system.


METHODS
Veterans enrolled in fee-for-service Medicare that had a VHA diagnosis of heart failure and a first prescription for carvedilol (n=17,429) or CR metoprolol (n=8,683) between October 1999 and September 2003.


METHODS
Prescribed daily doses and CR metoprolol-to-carvedilol hazard ratios (HRs) estimated using Cox regression within strata defined according to propensity to prescribe carvedilol.


RESULTS
After several months, the majority of prescribed doses in both cohorts were less than 50% of target doses. The risk-adjusted HR was 0.99 (95% confidence interval=0.96-1.03) for hospitalization or death and 0.91 (0.85-0.96) for death alone.


CONCLUSIONS
Doses of beta-blockers being prescribed to predominantly elderly veterans with heart failure were much lower than proven doses. Whether efforts to increase doses can improve the effectiveness of beta-blocker therapy warrants further study. At the prescribed doses, CR metoprolol was associated with better survival than carvedilol, although unmeasured confounding variables might explain the observed difference in survival.
Rector
Thomas S
TS
Minneapolis Veterans Affairs Medical Center and Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55417, USA. thomas.rector@va.gov
Anand
Inder S
IS
Nelson
David B
DB
Ensrud
Kristine E
KE
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000494:pharmacology; D000368:Aged; D000369:Aged, 80 and over; D002227:Carbazoles / Q000008:administration & dosage* / Q000494:pharmacology; D000077261:Carvedilol; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage* / Q000494:pharmacology; D010818:Practice Patterns, Physicians'; D011412:Propanolamines / Q000008:administration & dosage* / Q000494:pharmacology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D003692:Delayed-Action Preparations; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol