Long-term (3-month) effects of a new beta-blocker (nebivolol) on cardiac performance in dilated cardiomyopathy

Wisenbaugh, Thomas; Katz, Ivor; Davis, Jean; Essop, Rafique; Skoularigis, John; Middlemost, Shirley; Röthlisberger, Christian; Skudicky, Daniel; Sareli, Pinhas

doi:10.1016/0735-1097(93)90230-x

Cited by 140 publications

(56 citation statements)

References 24 publications

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“…The overall quality of the trials was high; each followed a double-blinded protocol, and only one study had possible irregularities in the randomization process (22). Follow-up of randomly assigned patients was almost complete.…”

Section: Resultsmentioning

confidence: 99%

β-Blockers in Congestive Heart Failure: A Bayesian Meta-Analysis

2001

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Purpose: Congestive heart failure is an important cause of patient morbidity and mortality. Although several randomized clinical trials have compared ␤-blockers with placebo for treatment of congestive heart failure, a meta-analysis quantifying the effect on mortality and morbidity has not been performed recently. Data Extraction: A specified protocol was followed to extract data on patient characteristics, ␤-blocker used, overall mortality, hospitalizations for congestive heart failure, and study quality.Data Synthesis: A hierarchical random-effects model was used to synthesize the results. A total of 22 trials involving 10 135 patients were identified. There were 624 deaths among 4862 patients randomly assigned to placebo and 444 deaths among 5273 patients assigned to ␤-blocker therapy. In these groups, 754 and 540 patients, respectively, required hospitalization for congestive heart failure. The probability that ␤-blocker therapy reduced total mortality and hospitalizations for congestive heart failure was almost 100%. The best estimates of these advantages are 3.8 lives saved and 4 fewer hospitalizations per 100 patients treated in the first year after therapy. The probability that these benefits are clinically significant (>2 lives saved or >2 fewer hospitalizations per 100 patients treated) is 99%. Both selective and nonselective agents produced these salutary effects. The results are robust to any reasonable publication bias.Conclusions: ␤-Blocker therapy is associated with clinically meaningful reductions in mortality and morbidity in patients with stable congestive heart failure and should be routinely offered to all patients similar to those included in trials. Ann Intern Med. 2001;134:550-560. www.annals.org For author affiliations, current addresses, and contributions, see end of text.C ongestive heart failure has reached pan-epidemic proportions in industrialized countries and is responsible for vast patient morbidity and mortality (1-4). Mortality associated with moderate to severe congestive heart failure may exceed that associated with many neoplasms, and the 1-year survival rate is as dismal as 50% (5). Quality of life is also adversely affected, and congestive heart failure is the most common cause of hospital admission in elderly persons in North America (6). Clearly, additional therapies are urgently needed.Randomized clinical trials are the gold standard for comparative research and have been used to investigate both new and old therapies for congestive heart failure. For example, trials have clearly demonstrated the beneficial effect of angiotensin-converting enzyme inhibitors on patient mortality (7), the neutral effect of digitalis (8), and the deleterious effects of other inotropic agents in congestive heart failure (9 -11).Although conventional medical education previously viewed congestive heart failure as a contraindication for the use of ␤-blockers because of their potential short-term negative inotropic effects, benefits of ␤-blocker treatment in this condition have been sporadica...

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Section: Resultsmentioning

confidence: 99%

β-Blockers in Congestive Heart Failure: A Bayesian Meta-Analysis

2001

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“…39 Labetalol has not been systematically investigated in heart failure populations but has been shown to improve myocardial function in subjects with hypertensive cardiomyopathy. 40 Another third-generation compound with limited but favorable experience 41,42 in heart failure trials is nebivolol, which is a markedly ␤ 1 -selective 43 compound whose vasodilatory action appears to be due to potentiation of nitric oxide. 44 Two other ␤-blockers with vasodilating activity, carvedilol and bucindolol, have been extensively evaluated in the treatment of chronic heart failure.…”

Section: Three Classes Of ␤-Blockers Available For Clinical Usementioning

confidence: 99%

“…47,56,58 However, some data also demonstrate no difference between a second-and third-generation compound. 59 Both second-and third-generation compounds improve intrinsic systolic function, 41,60,61 and prevent deterioration in function and progression in remodeling, [62][63][64][65][66] and reverse remodeling. 63,66 As discussed below, from a clinical standpoint it would appear that both second-and thirdgeneration compounds reduce hospitalizations and mortality, but quantitative differences in clinical responses may exist.…”

Section: Three Classes Of ␤-Blockers Available For Clinical Usementioning

confidence: 99%

β-Adrenergic Receptor Blockade in Chronic Heart Failure

2000

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“…The increase of CFR might also indicate an improvement of coronary microvascular dysfunction, responsible of microvascular angina pectoris or silent ischemia in patients without epicardial artery stenosis (32). The improvement of coronary microvessel function could be even one of the mechanisms sustaining the improvement of LV function demonstrated by both carvedilol and nebivolol (33)(34)(35)(36)(37)(38)(39)(40). Sugioka and coworkers (17) observed that CFVR improvement after carvedilol was greater in patients with LV ejection fraction increase ≥ 10% (1.3 ± 0.6) than in those with election fraction increase < 10% (0.4 ± 0.5) (p<0.01).…”

Section: Third Generation Beta-blockers (With Vasodilating Action) Anmentioning

confidence: 99%