Real-World Use of Carvedilol in Children With Dilated Cardiomyopathy: Long-Term Effect on Survival and Ventricular Function

Abstract

BackgroundCarvedilol is recommended for chronic heart failure (HF) treatment in children. However, the ideal dosage and administration are not standardized, and data on its long-term effects are lacking. This study aimed to assess the effect of a high dosage regimen of carvedilol on cardiac outcomes in children with HF.MethodsWe conducted a retrospective cohort study including all children with HF and dilated cardiomyopathy. We analyzed medical records before starting treatment, at 1 and 3 years after reaching the maximum therapeutic dosage. All data were compared with a historical control group. Kaplan–Meier analysis and Cox proportional hazard regression have been used to evaluate the effect of high dosage carvedilol therapy. The main outcome was a composite of all-cause mortality and heart transplant.ResultsOne hundred thirty-five were included in the study and 65 treated with a high dosage of carvedilol regimen (up to 1 mg/kg/day). Heart rate reduction (mean reduction 30%, p < 0.0001) and ejection fraction improvement (32 ± 9.4 vs. 45. ± 10.1%, p < 0.0001) were statistically significant in those. Long-term survival and freedom from heart transplant were significantly improved in those treated with high dosage carvedilol therapy (p = 0.00001).ConclusionsTreatment with the high dosage of carvedilol, in addition to standard HF therapy, significantly improves ventricular function and survival in children with dilated cardiomyopathy and chronic HF.

Pediatric dilated cardiomyopathy: a review of current clinical approaches and pathogenesis

“…Meanwhile adults are known to improve with β-blockers therapy ( 98 ). This lack of strong data for the pharmacologic efficacy of β-blockers in pediatric DCM likely stems from the unique molecular adaptations of cardiomyocytes seen in children ( 97 , 99 , 100 ). Carvedilol, in combination with other medications, is known, however, to improve fractional shortening, reduce LV size, and decrease natriuretic peptide levels in children ( 101 ).…”

Antiarrhythmic Drug Dosing in Children—Review of the Literature

“…Carvedilol's half-life is reported to be up to 3.6 h. The onset of action is reported within 1 h following administration, with an earlier alpha blocking effect (within 30 min) and later onset beta blocking effect. Carvedilol may cause arterial hypotension, dizziness, fatigue, weight gain, or hyperglycemia, among others [46][47][48][49][50][51].…”