PMID- 11083738
OWN - NLM
STAT- MEDLINE
DCOM- 20001207
LR  - 20190503
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Print)
IS  - 1355-6037 (Linking)
VI  - 84
IP  - 6
DP  - 2000 Dec
TI  - Baseline predictors of tolerability to carvedilol in patients with chronic heart 
      failure.
PG  - 615-9
AB  - OBJECTIVE: To determine baseline predictors of tolerance to the alpha/beta 
      blocker carvedilol in everyday clinical practice. DESIGN: Retrospective analysis 
      of tolerance to carvedilol in patients with chronic heart failure. Tolerance was 
      defined as currently on carvedilol or on it at the time of death or heart 
      transplantation. To meet the criteria for tolerance, carvedilol had to be 
      prescribed at a stable dose for >/= 3 months. SETTING: Everyday clinical 
      practice, comprising both hospital specialist practice and private practice. 
      Tolerance was assessed in all patients prescribed carvedilol for chronic heart 
      failure in those practices. PATIENTS: 808 consecutive patients in both hospital 
      specialist (611 patients) and private practice (197 patients). MAIN OUTCOME 
      MEASURES: Baseline predictors of tolerance assessed by proportional hazards 
      analysis. Both univariate and multivariate analyses were performed. RESULTS: 
      Within the entire cohort of 808 patients, 95 had stopped carvedilol, 606 were 
      currently receiving the drug, 50 had died, and 44 had received a heart 
      transplant. Overall, 88% of patients tolerated carvedilol (87% in the hospital 
      specialist group, 92% in the private practitioner group). Factors that indicated 
      impaired tolerance by univariate analysis were increased age in years (hazard 
      ratio 1.01, 95% confidence interval (CI) 1.0 to 1.3), low diastolic blood 
      pressure (hazard ratio 1.04, 95% CI 1.02 to 1.08), and raised plasma urea 
      concentration (hazard ratio 1.04, 95% CI 1.02 to 1.05). New York Heart 
      Association (NYHA) class was also a marker of tolerance (proportion not 
      tolerated: 3% class I; 9% class II; 13% class III, 22% class IV). By multivariate 
      analysis, no single baseline variable was an independent marker of inability to 
      tolerate carvedilol. Tolerance was also assessed in relation to traditional 
      precautions or relative contraindications to beta blockade. Tolerance in these 
      subgroups was: chronic obstructive airways disease/asthma 85% (89 patients), 
      diabetes 86% (127 patients), peripheral vascular disease 84% (58 patients), 
      concomitant amiodarone treatment 83% (230 patients), and heart rate < 70 
      beats/min 84% (184 patients). CONCLUSIONS: beta Blocker treatment was well 
      tolerated in everyday clinical practice, including non-hospital-based private 
      practice. There was no single predictor of poor tolerance on multivariate 
      analysis, although there was a clear association with NYHA class as well as age, 
      diastolic blood pressure, and plasma urea on univariate analysis. Carvedilol was 
      tolerated well among selected patients with traditional contraindications to beta 
      blockade in this situation.
FAU - Krum, H
AU  - Krum H
AD  - Clinical Pharmacology Unit, Department of Epidemiology and Preventive Medicine, 
      Department of Medicine, Monash University/Alfred Hospital, Prahran, Victoria, 
      Australia.henry.krum@med.monash.edu.au
FAU - Ninio, D
AU  - Ninio D
FAU - MacDonald, P
AU  - MacDonald P
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0 (Vasodilator Agents)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
MH  - Adolescent
MH  - Adrenergic beta-Antagonists/adverse effects/*therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Carbazoles/adverse effects/*therapeutic use
MH  - Carvedilol
MH  - Child
MH  - Child, Preschool
MH  - Contraindications
MH  - Drug Administration Schedule
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Middle Aged
MH  - Propanolamines/adverse effects/*therapeutic use
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Vasodilator Agents/*therapeutic use
PMC - PMC1729537
EDAT- 2000/11/18 11:00
MHDA- 2001/02/28 10:01
PMCR- 2003/12/01
CRDT- 2000/11/18 11:00
PHST- 2000/11/18 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/11/18 11:00 [entrez]
PHST- 2003/12/01 00:00 [pmc-release]
AID - 10.1136/heart.84.6.615 [doi]
PST - ppublish
SO  - Heart. 2000 Dec;84(6):615-9. doi: 10.1136/heart.84.6.615.