PMID- 16764329
OWN - NLM
STAT- MEDLINE
DCOM- 20060630
LR  - 20221207
IS  - 0914-5087 (Print)
IS  - 0914-5087 (Linking)
VI  - 47
IP  - 5
DP  - 2006 May
TI  - [Long-term outcome and tolerability of carvedilol therapy in Japanese patients 
      with chronic heart failure].
PG  - 229-37
AB  - OBJECTIVES: Randomized controlled clinical studies in western countries have 
      shown that the beta-blockers improve the survival of patients with chronic heart 
      failure and are highly tolerable. The tolerability of beta-blocker therapy and 
      the long-term prognosis for patients with chronic heart failure receiving 
      beta-blockers remain unclear in Japan. In the present study, carvedilol was 
      employed for the treatment of mild to severe chronic heart failure and the 
      long-term prognosis of the patients was monitored to evaluate the tolerability 
      and chronic efficacy of beta-blocker therapy in Japanese patients. METHODS: Three 
      hundred and twenty-seven patients with chronic heart failure [Classes II to IV 
      according to the New York Heart Association (NYHA) classification] were studied. 
      Carvedilol was started at a dose of 1.25 to 5 mg/day and then increased to the 
      final target dose of 20 mg/day, depending on its tolerability in each patient. 
      The patients were monitored with respect to their NYHA classification, daily mean 
      heart rate (evaluated by Holter electrocardiography), changes of the plasma brain 
      natriuretic peptide level, and prognosis. They were followed up for a mean period 
      of 4.4 +/- 1.8 years. RESULTS: Carvedilol was not tolerated by 21 of the 327 
      patients (6.4%), and was discontinued during the follow-up period in 38 patients 
      (11.6%). The mean maintenance dose for the remaining 268 patients (82.0%), in 
      whom treatment could be continued over the long term, was 14.1 +/- 7.5 mg. The 
      NYHA classification and plasma brain natriuretic peptide level were significantly 
      improved, and the daily mean heart rate was also significantly reduced in the 268 
      patients. Significant improvement was also observed in patients with severe heart 
      failure (classes III or IV of the NYHA classification). The five-year survival 
      rate of patients continuously treated with carvedilol was 83%, and their outcome 
      was significantly better than that of those who could not tolerate the drug (49%; 
      p < 0.001) or those who discontinued treatment prematurely (68%; p < 0.001). The 
      treated group also had a significantly lower cardiac death rate than the 
      intolerant group or discontinued group. CONCLUSIONS: Carvedilol was well 
      tolerated by Japanese patients with chronic heart failure. Treatment with 
      low-dose carvedilol may improve the symptoms and prognosis of patients with mild 
      to severe chronic heart failure over the long term.
FAU - Kawashiro, Naomi
AU  - Kawashiro N
AD  - Department of Cardiology, Tokyo Women's Medical University, Tokyo.
FAU - Matsuda, Naoki
AU  - Matsuda N
FAU - Endo, Yoko
AU  - Endo Y
FAU - Uchida, Yoshie
AU  - Uchida Y
FAU - Kasanuki, Hiroshi
AU  - Kasanuki H
LA  - jpn
PT  - Journal Article
PL  - Netherlands
TA  - J Cardiol
JT  - Journal of cardiology
JID - 8804703
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Adrenergic beta-Antagonists/administration & dosage/*therapeutic use
MH  - Asian People
MH  - Carbazoles/administration & dosage/*therapeutic use
MH  - Carvedilol
MH  - Drug Tolerance
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*drug therapy/mortality
MH  - Heart Rate
MH  - Humans
MH  - Japan
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Prognosis
MH  - Propanolamines/administration & dosage/*therapeutic use
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2006/06/13 09:00
MHDA- 2006/07/01 09:00
CRDT- 2006/06/13 09:00
PHST- 2006/06/13 09:00 [pubmed]
PHST- 2006/07/01 09:00 [medline]
PHST- 2006/06/13 09:00 [entrez]
PST - ppublish
SO  - J Cardiol. 2006 May;47(5):229-37.