PMID- 10376614
OWN - NLM
STAT- MEDLINE
DCOM- 19990629
LR  - 20220330
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 353
IP  - 9169
DP  - 1999 Jun 12
TI  - Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised 
      Intervention Trial in Congestive Heart Failure (MERIT-HF).
PG  - 2001-7
AB  - BACKGROUND: Metoprolol can improve haemodynamics in chronic heart failure, but 
      survival benefit has not been proven. We investigated whether metoprolol 
      controlled release/extended release (CR/XL) once daily, in addition to standard 
      therapy, would lower mortality in patients with decreased ejection fraction and 
      symptoms of heart failure. METHODS: We enrolled 3991 patients with chronic heart 
      failure in New York Heart Association (NYHA) functional class II-IV and with 
      ejection fraction of 0.40 or less, stabilised with optimum standard therapy, in a 
      double-blind randomised controlled study. Randomisation was preceded by a 2-week 
      single-blind placebo run-in period. 1990 patients were randomly assigned 
      metoprolol CR/XL 12.5 mg (NYHA III-IV) or 25.0 mg once daily (NYHA II) and 2001 
      were assigned placebo. The target dose was 200 mg once daily and doses were 
      up-titrated over 8 weeks. Our primary endpoint was all-cause mortality, analysed 
      by intention to treat. FINDINGS: The study was stopped early on the 
      recommendation of the independent safety committee. Mean follow-up time was 1 
      year. All-cause mortality was lower in the metoprolol CR/XL group than in the 
      placebo group (145 [7.2%, per patient-year of follow-up]) vs 217 deaths [11.0%], 
      relative risk 0.66 [95% CI 0.53-0.81]; p=0.00009 or adjusted for interim analyses 
      p=0.0062). There were fewer sudden deaths in the metoprolol CR/XL group than in 
      the placebo group (79 vs 132, 0.59 [0.45-0.78]; p=0.0002) and deaths from 
      worsening heart failure (30 vs 58, 0.51 [0.33-0.79]; p=0.0023). INTERPRETATION: 
      Metoprolol CR/XL once daily in addition to optimum standard therapy improved 
      survival. The drug was well tolerated.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Delayed-Action Preparations)
RN  - GEB06NHM23 (Metoprolol)
SB  - IM
CIN - ACP J Club. 2000 Jan-Feb;132(1):3
CIN - Lancet. 1999 Jun 12;353(9169):1988-9. PMID: 10376609
CIN - Lancet. 1999 Oct 23;354(9188):1471-2. PMID: 10543692
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiovascular Diseases/mortality
MH  - Death, Sudden
MH  - Delayed-Action Preparations
MH  - Double-Blind Method
MH  - Female
MH  - Heart Failure/*drug therapy/mortality
MH  - Humans
MH  - Male
MH  - Metoprolol/*therapeutic use
MH  - Middle Aged
MH  - Survival Rate
EDAT- 1999/06/22 10:00
MHDA- 2000/03/11 09:00
CRDT- 1999/06/22 10:00
PHST- 1999/06/22 10:00 [pubmed]
PHST- 2000/03/11 09:00 [medline]
PHST- 1999/06/22 10:00 [entrez]
AID - S0140673699044402 [pii]
PST - ppublish
SO  - Lancet. 1999 Jun 12;353(9169):2001-7.