PMID- 10714728
OWN - NLM
STAT- MEDLINE
DCOM- 20000316
LR  - 20220330
IS  - 0098-7484 (Print)
IS  - 0098-7484 (Linking)
VI  - 283
IP  - 10
DP  - 2000 Mar 8
TI  - Effects of controlled-release metoprolol on total mortality, hospitalizations, 
      and well-being in patients with heart failure: the Metoprolol CR/XL Randomized 
      Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group.
PG  - 1295-302
AB  - CONTEXT: Results from recent studies on the effects of beta1-blockade in patients 
      with heart failure demonstrated a 34% reduction in total mortality. However, the 
      effect of beta1-blockade on the frequency of hospitalizations, symptoms, and 
      quality of life in patients with heart failure has not been fully explored. 
      OBJECTIVE: To examine the effects of the beta1-blocker 
      controlled-release/extended-release metoprolol succinate (metoprolol CR/XL) on 
      mortality, hospitalization, symptoms, and quality of life in patients with heart 
      failure. DESIGN: Randomized, double-blind controlled trial, preceded by a 2-week 
      single-blind placebo run-in period, conducted from February 14, 1997, to October 
      31, 1998, with a mean follow-up of 1 year. SETTING: Three hundred thirteen sites 
      in 14 countries. PARTICIPANTS: Patients (n = 3991) with chronic heart failure, 
      New York Heart Association (NYHA) functional class II to IV, and ejection 
      fraction of 0.40 or less who were stabilized with optimum standard therapy. 
      INTERVENTIONS: Patients were randomized to metoprolol CR/XL, 25 mg once per day 
      (NYHA class II), or 12.5 mg once per day (NYHA class III or IV), titrated for 6 
      to 8 weeks up to a target dosage of 200 mg once per day (n = 1990); or matching 
      placebo (n = 2001). MAIN OUTCOME MEASURES: Total mortality or any hospitalization 
      (time to first event), number of hospitalizations for worsening heart failure, 
      and change in NYHA class, by intervention group; quality of life was assessed in 
      a substudy of 741 patients. RESULTS: The incidence of all predefined end points 
      was lower in the metoprolol CR/XL group than in the placebo group, including 
      total mortality or all-cause hospitalizations (the prespecified second primary 
      end point; 641 vs 767 events; risk reduction, 19%; 95% confidence interval [CI], 
      10%-27%; P<.001); total mortality or hospitalizations due to worsening heart 
      failure (311 vs 439 events; risk reduction, 31%; 95% CI, 20%-40%; P<.001), number 
      of hospitalizations due to worsening heart failure (317 vs 451; P<.001); and 
      number of days in hospital due to worsening heart failure (3401 vs 5303 days; 
      P<.001). NYHA functional class, assessed by physicians, and McMaster Overall 
      Treatment Evaluation score, assessed by patients, both improved in the metoprolol 
      CR/XL group compared with the placebo group (P = .003 and P = .009, 
      respectively). CONCLUSIONS: In this study of patients with symptomatic 
      heartfailure, metoprolol CR/XL improved survival, reduced the need for 
      hospitalizations due to worsening heart failure, improved NYHA functional class, 
      and had beneficial effects on patient well-being.
FAU - Hjalmarson, A
AU  - Hjalmarson A
AD  - Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden.
FAU - Goldstein, S
AU  - Goldstein S
FAU - Fagerberg, B
AU  - Fagerberg B
FAU - Wedel, H
AU  - Wedel H
FAU - Waagstein, F
AU  - Waagstein F
FAU - Kjekshus, J
AU  - Kjekshus J
FAU - Wikstrand, J
AU  - Wikstrand J
FAU - El Allaf, D
AU  - El Allaf D
FAU - Vitovec, J
AU  - Vitovec J
FAU - Aldershvile, J
AU  - Aldershvile J
FAU - Halinen, M
AU  - Halinen M
FAU - Dietz, R
AU  - Dietz R
FAU - Neuhaus, K L
AU  - Neuhaus KL
FAU - Janosi, A
AU  - Janosi A
FAU - Thorgeirsson, G
AU  - Thorgeirsson G
FAU - Dunselman, P H
AU  - Dunselman PH
FAU - Gullestad, L
AU  - Gullestad L
FAU - Kuch, J
AU  - Kuch J
FAU - Herlitz, J
AU  - Herlitz J
FAU - Rickenbacher, P
AU  - Rickenbacher P
FAU - Ball, S
AU  - Ball S
FAU - Gottlieb, S
AU  - Gottlieb S
FAU - Deedwania, P
AU  - Deedwania P
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Delayed-Action Preparations)
RN  - GEB06NHM23 (Metoprolol)
SB  - IM
CIN - JAMA. 2000 Mar 8;283(10):1335-7. PMID: 10714735
CIN - JAMA. 2000 Jul 26;284(4):436; author reply 436-7. PMID: 10904492
CIN - JAMA. 2000 Jul 26;284(4):436; author reply 436-7. PMID: 10904493
MH  - Adrenergic beta-Antagonists/administration & dosage/*therapeutic use
MH  - Delayed-Action Preparations
MH  - Double-Blind Method
MH  - Female
MH  - Heart Failure/*drug therapy/mortality/physiopathology
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Metoprolol/administration & dosage/*analogs & derivatives/therapeutic use
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Quality of Life
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2000/03/14 09:00
MHDA- 2000/03/18 09:00
CRDT- 2000/03/14 09:00
PHST- 2000/03/14 09:00 [pubmed]
PHST- 2000/03/18 09:00 [medline]
PHST- 2000/03/14 09:00 [entrez]
AID - joc92053 [pii]
AID - 10.1001/jama.283.10.1295 [doi]
PST - ppublish
SO  - JAMA. 2000 Mar 8;283(10):1295-302. doi: 10.1001/jama.283.10.1295.