PMID- 24118421
OWN - NLM
STAT- MEDLINE
DCOM- 20140310
LR  - 20220409
IS  - 1365-2796 (Electronic)
IS  - 0954-6820 (Linking)
VI  - 275
IP  - 2
DP  - 2014 Feb
TI  - The large-scale placebo-controlled beta-blocker studies in systolic heart failure 
      revisited: results from CIBIS-II, COPERNICUS and SENIORS-SHF compared with 
      stratified subsets from MERIT-HF.
PG  - 134-43
LID - 10.1111/joim.12141 [doi]
AB  - AIMS: The four pivotal beta-blocker trials in heart failure (HF) had different 
      inclusion criteria, making comparison difficult without patient stratifying. The 
      aim of this study was to compare, in similar patients, the effects of bisoprolol, 
      metoprolol controlled release/extended release (CR/XL), carvedilol and nebivolol 
      on (i) total mortality, (ii) all-cause mortality or hospitalization due to 
      cardiovascular causes (time to first event), (iii) all-cause mortality or 
      hospitalization because of HF and (iv) tolerability, defined as discontinuation 
      of randomized treatment. METHODS: We compared stratified (s ) subsets in MERIT-HF 
      with patients in CIBIS-II [New York Heart Association (NYHA) class III/IV and 
      ejection fraction (EF) </= 35%] and COPERNICUS (NYHA III/IV and EF <25%) and in 
      patients with systolic HF in SENIORS-SHF (age >/= 70 years and EF </= 35%). RESULTS: 
      The annual mortality rates in the placebo and beta-blocker arms were: (i) 
      CIBIS-II (n = 2647), 13.2% vs. 8.8% (relative risk reduction 34%, 95% CI: 19-46, 
      P < 0.0001) and MERIT-HFs (n = 2002), 14.8% vs. 8.6% (relative risk reduction 
      42%, 95% CI: 24-56, P < 0.0001); (ii) COPERNICUS (n = 2289), 19.7% vs. 12.8% 
      (relative risk reduction 35%, 95% CI: 19-48, P = 0.0014) and MERIT-HFs (n = 795), 
      19.1% vs. 11.7% (relative risk reduction 39%; 95% CI: 11-58, P = 0.0086); (iii) 
      SENIORS-SHF (n = 1359), 11.3% vs. 9.7% (relative risk reduction 16%, NS) and 
      MERIT-HFs (n = 985), 14.8% vs. 10.1% (relative risk reduction 32%, 95% CI: 2-53, 
      P = 0.038). The effects on the other outcomes assessed were similar. Analyses 
      indicated fewer discontinuations from randomized treatment on beta-blockers 
      compared with placebo in COPERNICUS and the MERIT-HFs subsets. CONCLUSION: The 
      efficacy and tolerability of bisoprolol, carvedilol and metoprolol CR/XL are 
      similar in patients with systolic HF, irrespective of NYHA class or ejection 
      fraction. Nebivolol is less effective and not better tolerated.
CI  - (c) 2013 The Association for the Publication of the Journal of Internal Medicine.
FAU - Wikstrand, J
AU  - Wikstrand J
AD  - Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, 
      Gothenburg University, Gothenburg, Sweden.
FAU - Wedel, H
AU  - Wedel H
FAU - Castagno, D
AU  - Castagno D
FAU - McMurray, J J V
AU  - McMurray JJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20131024
PL  - England
TA  - J Intern Med
JT  - Journal of internal medicine
JID - 8904841
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Benzopyrans)
RN  - 0 (Carbazoles)
RN  - 0 (Delayed-Action Preparations)
RN  - 0 (Ethanolamines)
RN  - 0 (Propanolamines)
RN  - 030Y90569U (Nebivolol)
RN  - 0K47UL67F2 (Carvedilol)
RN  - GEB06NHM23 (Metoprolol)
RN  - Y41JS2NL6U (Bisoprolol)
SB  - IM
MH  - Adrenergic beta-Antagonists/administration & dosage/adverse effects/*therapeutic 
      use
MH  - Adult
MH  - Aged
MH  - Benzopyrans/therapeutic use
MH  - Bisoprolol/therapeutic use
MH  - Carbazoles/therapeutic use
MH  - Carvedilol
MH  - Delayed-Action Preparations
MH  - Ethanolamines/therapeutic use
MH  - Female
MH  - Heart Failure, Systolic/*drug therapy/*mortality/physiopathology
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Metoprolol/therapeutic use
MH  - Middle Aged
MH  - Nebivolol
MH  - Propanolamines/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Risk
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Treatment Outcome
OTO - NOTNLM
OT  - beta-blockers
OT  - clinical trials
OT  - heart failure
EDAT- 2013/10/15 06:00
MHDA- 2014/03/13 06:00
CRDT- 2013/10/15 06:00
PHST- 2013/10/15 06:00 [entrez]
PHST- 2013/10/15 06:00 [pubmed]
PHST- 2014/03/13 06:00 [medline]
AID - 10.1111/joim.12141 [doi]
PST - ppublish
SO  - J Intern Med. 2014 Feb;275(2):134-43. doi: 10.1111/joim.12141. Epub 2013 Oct 24.