Author + information
- Martin Huth Ruwald,
- Anne-Christine Ruwald,
- Christian Jøns,
- Jeffrey Alexis,
- Scott McNitt,
- Wojciech Zareba and
- Arthur Moss
The impact of beta-blockers in heart failure (HF) patients in NYHA class I and II with devices has not yet been investigated. The present study aim was to compare the effects of carvedilol and metoprolol in the MADIT-CRT study.
Using multivariate time-dependent Cox proportional hazard regression analyses we compared all patients receiving either carvedilol or metoprolol (N=1,515) on the endpoints of hospitalization for HF or death and ventricular arrhythmias.
Hospitalization for HF or death occurred in 30% of the patients on metoprolol and in 23% on carvedilol. Treatment with carvedilol was associated with a significantly decreased risk of hospitalization for HF or death when compared to metoprolol (HR 0.70, [CI: 0.57-0.87], p=0.001). The risk reduction was further attenuated in the sub-group of CRT-D patients (HR 0.62 [CI: 0.46-0.83], p=0.001) and CRT-D patients with left bundle branch block (LBBB) (HR 0.51 [CI: 0.35-0.76], p<0.001) (Figure). Ventricular arrhythmias occurred in 26% and in 22% of the patients receiving metoprolol or carvedilol, (HR 0.80, [CI: 0.63-1.00], p=0.050). A dose dependent relationship with decreasing risk of hospitalization for HF or death was found for carvedilol but not metoprolol.
Carvedilol compared to metoprolol was associated with a significant reduction in heart failure hospitalizations, death and ventricular arrhythmias and proved a pronounced beneficial and synergistic effect in patients with CRT-D and LBBB.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Devices II – Improving Outcomes in Patients with Implantable Devices: Tweaking the Well-Functioning Machine
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1190-39
- 2013 American College of Cardiology Foundation