title: Comparison of metoprolol succinate versus carvedilol in time to cardiovascular admission in a Veterans Affairs healthcare system: An observational study.
abstract: OBJECTIVE
  To determine if metoprolol succinate or carvedilol is more effective in delaying the time to first cardiovascular disease hospital admission in systolic heart failure patients. As a secondary objective, to determine the most effective dose of each agent in delaying first cardiovascular disease hospital admission, including but not limited to heart failure exacerbation, myocardial infarction, ischemic heart disease, cardiac arrhythmias, or death.
  
  
  METHODS
  This study was a retrospective chart review of 272 veterans at the VA Boston Healthcare System newly started on metoprolol succinate (n = 157) or carvedilol (n = 115) between January 2000 and December 2008. After an 8-week study medication titration period, subjects were subcategorized into low-, medium-, and high-dose ranging groups and followed until the first cardiovascular disease hospitalization, death, or 365 days. The main outcome measure was time to first cardiovascular hospitalization or death.
  
  
  RESULTS
  The mean age (69.9 years vs. 67.9 years) and ejection fraction (26% vs. 25%) were comparable between study arms at baseline. Mean time to first cardiovascular disease hospitalization was significantly different (p = 0.001) between study groups with 330.6 days with in metoprolol succinate group vs. 282.6 days in the carvedilol groups. High-dose carvedilol significantly delayed time to first hospitalization in comparison to medium or low carvedilol doses (p = 0.015, p = 0.005). Low- and high-dose metoprolol succinate were not significantly different (p = 0.509) in time to first event, and both dosing groups fared better compared to medium dose metoprolol succinate (p = 0.046).
  
  
  CONCLUSIONS
  In this veteran patient population in need of additional heart failure treatments, metoprolol succinate use resulted in a delayed time to first cardiovascular disease hospitalization or death compared to carvedilol. Both low and high doses of metoprolol succinate showed a significant delay of time to first cardiovascular hospitalization compared to medium doses of metoprolol succinate. Higher doses of carvedilol showed a significant delay of time to cardiovascular hospitalization than lower carvedilol doses.
authors.affiliation: Clinical Pharmacy Specialist, Syracuse VA Medical Center kara.church2@va.gov.
authors.forename: Kara M
authors.initials: KM
authors.lastname: Church
authors.affiliation: Clinical Pharmacy Manager, VA Boston Healthcare System.
authors.forename: Robert
authors.initials: R
authors.lastname: Henalt
authors.affiliation: Biostatistician, VA Boston Healthcare System.
authors.forename: Errol
authors.initials: E
authors.lastname: Baker
authors.affiliation: Clinical Pharmacist, VA Boston Healthcare System.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Clinical Pharmacist, VA Boston Healthcare System.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Brennan
authors.affiliation: Cardiologist, VA Boston Healthcare System.
authors.forename: Jacob
authors.initials: J
authors.lastname: Joseph
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006787:Hospitals, Veterans / Q000639:trends; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D011412:Propanolamines / Q000627:therapeutic use*; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000639:trends; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol