An intrinsic prognostic difference between carvedilol and metoprolol succinate, however, seems not to exist when used at equivalent doses.
The effect of different generations of beta blockers has been debated.
Limitations A potential limitation to this study is its observational design. Beta 1- and beta 2-adrenergic-receptor subpopulations in nonfailing and failing human ventricular myocardium: The reason for the vasodilating property of bucindolol has not clearly been demonstrated, but it may be because of an intrinsic sympatomimetic effect. Three beta-blockers—carvedilol, metoprolol, and bisoprolol—reduce mortality in chronic heart failure caused by left ventricular systolic dysfunction, when used in addition to diuretics and angiotensin converting enzyme ACE inhibitors strength of recommendation [SOR]: Bucindolol also has a vasodilating property.
Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart. As with COMET, more patients on carvedilol in our general cohort received target doses when compared with patients on metoprolol.
Temporary changes in therapy that did not persist until a four-month assessment were ignored. Patients with a contraindication to a beta-blocker, uncontrolled hypertension, major valvular disease, or a major vascular event or ventricular arrhythmia within the previous two months were excluded.
Beta-adrenergic blockade is of proven value in chronic heart failure. In this study patients with CHF were randomized to receive either carvedilol or placebo Packer et al But when follow up was extended a beneficial effect on mortality was indeed observed with IR metroprolol MDC Randomized active-controlled study comparing effects of treatment with carvedilol versus metoprolol in patients with left ventricular dysfunction after acute myocardial infarction.
More in Cardiology
Bias Reduction, Balance, and Sensitivity Analysis Balance of baseline covariates before and after matching was assessed using standardized differences 2425 and the efficacy of discrimination of the model using C-statistic. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Well-being and symptoms The primary analysis of interest was conducted using a five-point scoring system asking patients how well they felt every four months.
If a scheduled measurement of well-being was missed, average health state could be calculated using the next measurement and averaging over a longer period. Figure 4 Comparison of percentage of days alive lost due to poor well-being in patients randomized to carvedilol or metoprolol using four different sets of scores.
In addition, real-life patients with CHF differ from patients included in randomized trials. The number of patients included in each participating center is shown in Table I in the Data Supplement.
Bias Reduction, Balance, and Sensitivity Analysis Our results were supported by the formal sensitivity analysis.
Adjustment of quality-of-life scores because of increasing diuretic requirements caused the loss of 1. Then the first step of the matching process was repeated to identify the next closest match to the carvedilol patient of the failed match according to the propensity score. In all trials, the majority of subjects were taking diuretics and either an ACE inhibitor or angiotensin receptor blocker. Myocardial gene expression in dilated cardiomyopathy treated with beta-blocking agents.