Charlene Laino

March 17, 2006

March 17, 2006 (Atlanta) — Tens of thousands of lives could be saved if all eligible patients hospitalized with heart failure were discharged on beta-blockers, according to researchers who found that risk of death among patients receiving carvedilol at discharge was less than half of that of nontreated patients.

"Discharge use of carvedilol, or one of the other guideline-recommended beta-blockers, should be adopted as the standard of care among all hospitalized patients with heart failure and left ventricular systolic dysfunction, unless absolutely contraindicated," said chief investigator Gregg C. Fonarow, MD, from the University of California, Los Angeles.

The findings, presented here at the American College of Cardiology (ACC) 55th Annual Scientific Session, come from a new analysis of data from OPTIMIZE-HF, a national registry and performance improvement program for patients with heart failure.

A total of 2373 heart failure patients with left ventricular systolic dysfunction were eligible to receive beta-blocker therapy. Of those patients, 1162 (49%) were prescribed carvedilol at discharge, 820 (35%) were discharged on another beta-blocker, and 382 (16%) did not get beta-blocker therapy.

The patients were followed for 60 to 90 days, the time period when they are at highest risk for rehospitalization or death, Dr. Fonarow said.

At follow-up, carvedilol use was associated with a lower risk of all-cause mortality: 5.6% vs 11.1% (P = .0003) in the nontreated group. Patients receiving carvedilol also had a lower, although nonsignificant, risk of rehospitalization: 29.0% vs 33.3% (P = .1165) and a significantly lower risk of death or rehospitalization: 32.5% vs 42% (P = .0008) in the nontreated group.

Noting that the risk of death was 51% lower among patients treated with carvedilol (P = .0004), Dr. Fonarow told Medscape, "Eight per 100 additional lives could be saved with this strategy."

Also, 94% of patients discharged on carvedilol remained on therapy for 60 to 90 days, Dr. Fonarow reported. "This suggests not only that the drug is well tolerated, but that hospitalization is a teachable moment. If patients are started then, they will remain on therapy and more importantly, will have a survival advantage."

Of the eligible patients who were not discharged with a prescription, only one third were later prescribed any beta-blocker, he added.

James H. Stein, MD, cochair of the scientific program committee for the ACC meeting and associate professor of medicine at the University of Wisconsin Medical School in Madison, told Medscape that the data analysis was "very slick" and the findings are "really exciting."

"It's hard to believe that it's been 10 years since we discovered how important beta-blocker therapy is in reducing morbidity and mortality," Dr. Stein said. "And just like with the statins, we keep on finding out how really potent they are."

ACC 55th Annual Scientific Session. Abstract 809-8. March 14, 2006.

Reviewed by Ariana Del Negro

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