PMID- 10091817
OWN - NLM
STAT- MEDLINE
DCOM- 19990407
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 33
IP  - 4
DP  - 1999 Mar 15
TI  - Tolerability and efficacy of carvedilol in patients with New York Heart 
      Association class IV heart failure.
PG  - 924-31
AB  - OBJECTIVES: The purpose of this study was to assess the tolerability and efficacy 
      of carvedilol in patients with New York Heart Association (NYHA) functional class 
      IV symptoms. BACKGROUND: Carvedilol, a nonselective beta-adrenergic blocking drug 
      with alpha-adrenergic blocking and antioxidant properties, has been shown to 
      improve left ventricular function and clinical outcome in patients with mild to 
      moderate chronic heart failure. METHODS: We retrospectively analyzed the outcomes 
      of 230 patients with heart failure treated with carvedilol who were stratified 
      according to baseline functional class: 63 patients were NYHA class IV and 167 
      were NYHA class I, II or III. Carvedilol was commenced at 3.125 mg b.i.d. and 
      titrated to 25 mg b.i.d. as tolerated. Patients with class IV symptoms were older 
      (p = 0.03), had lower left ventricular fractional shortening (p < 0.001), had 
      lower six-min walk distance (p < 0.001) and were receiving more heart failure 
      medications at baseline compared with less symptomatic patients. RESULTS: 
      Nonfatal adverse events while taking carvedilol occurred more frequently in class 
      IV patients (43% vs. 24%, p < 0.0001), and more often resulted in permanent 
      withdrawal of the drug (25% vs. 13%, p < 0.01). Thirty-seven (59%) patients who 
      were NYHA class IV at baseline had improved by one or more functional class at 3 
      months, 8 (13%) were unchanged and 18 (29%) had deteriorated or died. Among the 
      less symptomatic group, 62 (37%) patients had improved their NYHA status at 3 
      months, 73 (44%) were unchanged and 32 (19%) had deteriorated or died. The 
      differences in symptomatic outcome at three months between the two groups were 
      statistically significant (p = 0.001, chi-square analysis). Both groups 
      demonstrated similar significant improvements in left ventricular dimensions and 
      systolic function. CONCLUSIONS: Patients with chronic NYHA class IV heart failure 
      are more likely to develop adverse events during initiation and dose titration 
      when compared with less symptomatic patients but are more likely to show 
      symptomatic improvement in the long term. We conclude that carvedilol is a useful 
      adjunctive therapy for patients with NYHA class IV heart failure; however, they 
      require close observation during initiation and titration of the drug.
FAU - Macdonald, P S
AU  - Macdonald PS
AD  - Heart and Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia. 
      pmacdonald@stvincents.com.au
FAU - Keogh, A M
AU  - Keogh AM
FAU - Aboyoun, C L
AU  - Aboyoun CL
FAU - Lund, M
AU  - Lund M
FAU - Amor, R
AU  - Amor R
FAU - McCaffrey, D J
AU  - McCaffrey DJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
MH  - Actuarial Analysis
MH  - Adrenergic beta-Antagonists/adverse effects/*therapeutic use
MH  - Adult
MH  - Adverse Drug Reaction Reporting Systems
MH  - Aged
MH  - Australia
MH  - Carbazoles/adverse effects/*therapeutic use
MH  - Carvedilol
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Exercise Test/drug effects
MH  - Female
MH  - Heart Failure/classification/diagnosis/*drug therapy/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Propanolamines/adverse effects/*therapeutic use
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Function, Left/drug effects
EDAT- 1999/03/26 00:00
MHDA- 1999/03/26 00:01
CRDT- 1999/03/26 00:00
PHST- 1999/03/26 00:00 [pubmed]
PHST- 1999/03/26 00:01 [medline]
PHST- 1999/03/26 00:00 [entrez]
AID - S0735-1097(98)00680-9 [pii]
AID - 10.1016/s0735-1097(98)00680-9 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 1999 Mar 15;33(4):924-31. doi: 10.1016/s0735-1097(98)00680-9.