The SCOOP (SCOmpenso nella Ospedalizzazione Pubblica) trial in heart failure

Abstract

23+ 0.1, respectively; p = NS for both). Moreover the hospitalization days was significantly reduced by Dob program: in fact, only one patient were hospitalized in the follow-up time, with in-hospital stay of 6 and 7 days, respectively. Thus the mean hospitalization time in the survivors of study group resulted significantly decreased: 0.46 4-0.1 days after Dob program vs 20.4 4-1.8 days before Dob (p < 0.0001) in the same pts. In the 3 pts without response to Dob administration and death by worsening heart failure the mean hospitalization time was 29 4-2.5.Conclusion: Our data shows that Dob low-dose home administration is avalaible, safe, reduces hospitalizations and improves symptoms, resulting a suitable therapeutic option in selected pts with advanced heart failure. The purpose of the study was to investigate the effects on the left ventricle when treating chronic heart failure with the ~t-selective receptor antagonist metoprolol. The mechanism behind the mortality benefit from treatment of chronic heart failure with/%blockers remains yet to be fully elucidated and previous studies have presented insignificant or conflicting results regarding anti-remodelling effects on the left ventricle. Methods:In a substudy to the randomised, placebo-controlled and double-blind Metoprolol CR/XL Randomised Intervention Trial in Heart Failure (MERIT-HF), 41 patients were examined with magnetic resonance imaging at baseline, after 5 weeks and after 6 months of treatment with metoprolol (n = 19) or placebo (n = 22) assessing left ventricular dimensions and function.Results: Decreases in both left ventricular end-diastolic volume index (150 ml/m 2 at baseline to 126 ml/m at 6 months, P = 0.01) and left ventricular end-systolic volume index (107 ml/m 2 -81 ml/m 2, P = 0.001) were found, whereas left ventricular ejection fraction increased in the metoprolol group (29%-37%, P = 0.03). No significant changes were seen in the placebo group regarding these variables. Left ventricular stroke volume index remained unchanged, whereas left ventricular mass index decreased in both groups (175 g/m -160 g/m in the placebo group (P = 0.005) and 179 g/m 2 -164 g/m 2 in the metoprolol group (P = 0.01)). Conclusions:The current study is the first randomised trial to demonstrate that metoprolol has anti-remodelling effects on left ventricular dimensions and function in patients with chronic heart failure and consequenfly provides an explanation for the highly significant decrease in mortality from worsening heart failure found in the MERIT-HF trial. Background: Chronic heart failure (CHF) represents an increasing economical burden for public health and any strategy aiming to improve the cost effectiveness of its treatment is welcome. In a recent survey in our hospital (Eur J Heart failure 1999; 1: 411-17) we have shown that 97% of such patients (median age 72 yrs) are admitted in the general medicine departments (median hospital stay 8 days), all having at least one co-morbidity, and that 39% had been previously admitted.Ainl of the study: T...