Effect of Carvedilol on the Morbidity of Patients With Severe Chronic Heart Failure

Packer, Milton; Fowler, Michael B.; Roecker, Ellen B.; Coats, Andrew J.S.; Katus, Hugo A.; Krum, Henry; Mohaçsi, Paul; Rouleau, Jean L.; Tendera, Michał; Staiger, C; Holcslaw, Terry L.; Amann-Zalán, Ildikó; DeMets, David L.

doi:10.1161/01.cir.0000035653.72855.bf

Cited by 1,126 publications

(372 citation statements)

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“…Standard heart failure therapy is effective and refers to an angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), a beta‐blocker, and a mineralocorticoid antagonist 2. Even though standard treatment reduces risk of death and heart failure hospitalization by up to 10–37%,3, 4, 5, 6, 7, 8, 9 mortality is high, and many patients suffer from severe symptoms on a daily basis. New and more effective heart failure treatments are needed.…”

Section: Introductionmentioning

confidence: 99%

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

2018

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AimsThis study aims to investigate the eligibility of the Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor (ARNI) with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF) study to a real‐world heart failure population.Methods and resultsMedical records of all heart failure patients living within the catchment area of Umeå University Hospital were reviewed. This district consists of around 150 000 people. Out of 2029 patients with a diagnosis of heart failure, 1924 (95%) had at least one echocardiography performed, and 401 patients had an ejection fraction of ≤35% at their latest examination. The major PARADIGM‐HF criteria were applied, and 95 patients fulfilled all enrolment criteria and thus were eligible for sacubitril–valsartan. This corresponds to 5% of the overall heart failure population and 24% of the population with ejection fraction ≤ 35%. The eligible patients were significantly older (73.2 ± 10.3 vs. 63.8 ± 11.5 years), had higher blood pressure (128 ± 17 vs. 122 ± 15 mmHg), had higher heart rate (77 ± 17 vs. 72 ± 12 b.p.m.), and had more atrial fibrillation (51.6% vs. 36.2%) than did the PARADIGM‐HF population.ConclusionsOnly 24% of our real‐world heart failure and reduced ejection fraction population was eligible for sacubitril–valsartan, and the real‐world heart failure and reduced ejection fraction patients were significantly older than the PARADIGM‐HF population. The lack of data on a majority of the patients that we see in clinical practice is a real problem, and we are limited to extrapolation of results on a slightly different population. This is difficult to address, but perhaps registry‐based randomized clinical trials will help to solve this issue.

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Section: Introductionmentioning

confidence: 99%

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

2018

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“…Combined treatment with OMT and biventricular pacing has been shown to invoke marked reduction in HF/death events, which appear very early and are sustained 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. This benefit has been observed in patients with mild‐to‐severe HF symptoms in randomized studies 1, 2, 3, 4, 5, 6.…”

Section: Discussionmentioning

confidence: 97%

“…Cardiac resynchronization therapy has been recommended in patients with reduced LVEF and prolonged QRS who remain symptomatic despite optimal pharmacological therapy. However, some patients remain symptomatic and may not be treated with all of the recommended pharmacological treatments for comorbidity conditions or side effects such as hypotension, which inhibits up‐titrating to the maximum tolerated evidence‐based doses 7, 8, 9, 10, 11, 12, 13, 14. In the REVERSE study, only 35% of patients were on the target dose of BBs, and 60% were receiving 50% of the target dose 6.…”

Section: Discussionmentioning

confidence: 99%

“…Optimal medical therapy (OMT) consists of 3 neurohormonal antagonist drugs (angiotensin‐converting enzyme inhibitors [ACEIs] or angiotensin II receptor blockers [ARBs], beta‐blockers [BB], and mineralocorticoid receptor antagonist [MRAs]) that have been shown to improve survival, reduce hospitalizations for HF, and improve symptoms 7, 8, 9, 10, 11, 12, 13, 14. Nowadays, ACEIs/ARBs, BBs, and MRAs are cornerstones of HF, and they have class I recommendations in clinical guidelines 7.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy

Álvarez‐Álvarez

García‐Seara

Martínez‐Sande

et al. 2018

Journal of Arrhythmia

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BackgroundCardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy (OMT). However, many patients may not be under OMT when the CRT device is implanted. Here, we evaluate the long‐term benefits of CRT in symptomatic HF patients receiving or not OMT.MethodsWe investigated the effect of OMT on HF developing or death in 328 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. After the CRT implant, we categorized the patients into three groups: no OMT, OMT at baseline and after 1 year of follow‐up, and OMT only at the 1‐year follow‐up but not at baseline. We used multivariate Cox proportional hazards model to determine the effect of OMT on clinical outcomes.ResultsOne hundred and twenty‐two patients (37.2%) received OMT prior to CRT. OMT at baseline was not associated with a reduced risk of death or HF (HR 0.72; 95% CI 0.50‐1.02; P = 0.067) compared with no‐basal‐OMT patients. After CRT, patients without OMT had a higher risk of death or HF than patients who received OMT in follow‐up (HR 1.72, 95% CI 1.07‐2.78, P = 0.025), and the risk of the patients who received OMT at baseline and at the 1‐year follow‐up was similar to that of the patients who achieved OMT at the 1‐year follow‐up (HR 0.90, 95% CI 0.54‐1.50, P = 0.682).ConclusionBasal OMT prior to CRT is not associated with better outcomes in terms of HF/death compared with no basal OMT. The subgroup of patients who achieved OMT at the 1‐year follow‐up exhibited a reduced risk of HF and death compared with patients who did not.

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“…The landmark clinical trials that established the efficacy of beta‐blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) predominately consisted of white patients (80–99%),1, 2, 3, 4, 5, 6 despite evidence that black patients have higher risk for developing and dying from HF 7. Subgroup analyses of these pivotal trials show effect estimates that are consistent with treatment benefit across races (though very limited in terms of power),8, 9 and consensus guidelines reasonably recommend beta‐blocker use in all patients with HFrEF unless contraindicated 10.…”

Section: Introductionmentioning

confidence: 99%

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Peterson

She

et al. 2018

JAHA

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BackgroundIt remains unclear whether beta‐blockade is similarly effective in black patients with heart failure and reduced ejection fraction as in white patients, but self‐reported race is a complex social construct with both biological and environmental components. The objective of this study was to compare the reduction in mortality associated with beta‐blocker exposure in heart failure and reduced ejection fraction patients by both self‐reported race and by proportion African genetic ancestry.Methods and ResultsInsured patients with heart failure and reduced ejection fraction (n=1122) were included in a prospective registry at Henry Ford Health System. This included 575 self‐reported blacks (129 deaths, 22%) and 547 self‐reported whites (126 deaths, 23%) followed for a median 3.0 years. Beta‐blocker exposure (BBexp) was calculated from pharmacy claims, and the proportion of African genetic ancestry was determined from genome‐wide array data. Time‐dependent Cox proportional hazards regression was used to separately test the association of BBexp with all‐cause mortality by self‐reported race or by proportion of African genetic ancestry. Both sets of models were evaluated unadjusted and then adjusted for baseline risk factors and beta‐blocker propensity score. BBexp effect estimates were protective and of similar magnitude both by self‐reported race and by African genetic ancestry (adjusted hazard ratio=0.56 in blacks and adjusted hazard ratio=0.48 in whites). The tests for interactions with BBexp for both self‐reported race and for African genetic ancestry were not statistically significant in any model (P>0.1 for all).ConclusionsAmong black and white patients with heart failure and reduced ejection fraction, reduction in all‐cause mortality associated with BBexp was similar, regardless of self‐reported race or proportion African genetic ancestry.

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Effect of Carvedilol on the Morbidity of Patients With Severe Chronic Heart Failure

Cited by 1,126 publications

References 10 publications

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

Eligibility of sacubitril–valsartan in a real‐world heart failure population: a community‐based single‐centre study

Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

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