PMID- 9033462
OWN - NLM
STAT- MEDLINE
DCOM- 19970310
LR  - 20210503
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 349
IP  - 9049
DP  - 1997 Feb 8
TI  - Randomised, placebo-controlled trial of carvedilol in patients with congestive 
      heart failure due to ischaemic heart disease. Australia/New Zealand Heart Failure 
      Research Collaborative Group.
PG  - 375-80
AB  - BACKGROUND: In patients with heart failure, beta-blocker therapy improves 
      left-ventricular function after 3-6 months of treatment, but effects of such 
      treatment on symptoms and exercise performance are inconsistent, and the 
      longer-term effects on death and other serious clinical events remain uncertain. 
      We have investigated these issues in a double-blind, placebo-controlled, 
      randomised trial of the beta-adrenergic blocker carvedilol (which also has alpha 
      1-blocking properties). METHODS: 415 patients with chronic stable heart failure 
      were randomly assigned treatment with carvedilol (207) or matching placebo (208). 
      At baseline, 6 months, and 12 months, we measured left-ventricular ejection 
      fraction, left-ventricular dimensions, treadmill exercise duration, 6 min walk 
      distance, New York Heart Association (NYHA) class, and specific activity scale 
      (SAS) score. Double-blind follow-up continued for an average of 19 months, during 
      which all deaths, hospital admissions, and episodes of worsening heart failure 
      were documented. FINDINGS: After 12 months, left-ventricular ejection fraction 
      had increased by 5.3% (2p < 0.0001) and end-diastolic and end-systolic dimensions 
      had decreased by 1.7 mm (2p = 0.06) and 3.2 mm (2p = 0.001), respectively, in the 
      carvedilol group compared with the placebo group. During the same period that 
      were no clear changes in treadmill exercise duration, 6 min walk distance, NYHA 
      class, or SAS score. After 19 months, the frequency of episodes of worsening 
      heart failure was similar in the carvedilol and placebo groups (82 vs 75; 
      relative risk 1.12 [95% Cl 0.82-1.53]) but the rate of death or hospital 
      admission was lower in the carvedilol group than in the placebo group (104 vs 
      131; relative risk 0.74 [0.57-0.95]). INTERPRETATION: The beneficial effects of 
      carvedilol on left-ventricular function and size were maintained for at least a 
      year after the start of treatment, but carvedilol had no effect on exercise 
      performance, symptoms, or episodes of worsening heart failure. There was an 
      overall reduction in events resulting in death or hospital admission, and a year 
      of treatment with carvedilol resulted in the avoidance of one such serious event 
      among every 12-13 (SE 5) of these patients with chronic stable heart failure.
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 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
SB  - IM
CIN - ACP J Club. 1997 Jul-Aug;127(1):3
MH  - Adrenergic beta-Antagonists/administration & dosage/*therapeutic use
MH  - Aged
MH  - Australia
MH  - Carbazoles/administration & dosage/*therapeutic use
MH  - Carvedilol
MH  - Double-Blind Method
MH  - Exercise Test/drug effects
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*drug therapy/etiology/mortality
MH  - Heart Function Tests
MH  - Hemodynamics/drug effects
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Myocardial Ischemia/*complications
MH  - New Zealand
MH  - Propanolamines/administration & dosage/*therapeutic use
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left/drug effects
EDAT- 1997/02/08 00:00
MHDA- 1997/02/08 00:01
CRDT- 1997/02/08 00:00
PHST- 1997/02/08 00:00 [pubmed]
PHST- 1997/02/08 00:01 [medline]
PHST- 1997/02/08 00:00 [entrez]
AID - S0140673697800086 [pii]
PST - ppublish
SO  - Lancet. 1997 Feb 8;349(9049):375-80.