Beta-blocker therapy for heart failure outside the clinical trial setting: findings of a community-based registry |
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Authors: | Franciosa Joseph A Massie Barry M Lukas Mary Ann Nelson Jeanenne J Lottes Sandra Abraham William T Fowler Michael Gilbert Edward M Greenberg Barry;COHERE Participant Physicians |
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Institution: | a Mount Sinai School of Medicine and Weill Medical College, Cornell University, New York, NY, USA b Veterans Administration Medical Center and University of California San Francisco, San Francisco, Calif, USA c GlaxoSmithKline Pharmaceuticals, Philadelphia, Pa, USA d Consultant, GlaxoSmithKline Pharmaceuticals, Philadelphia, Pa, USA e Ohio State University School of Medicine, Columbus, Ohio, USA f Stanford University Medical Center, Palo Alto, Calif, USA g University of Utah Medical Center, Salt Lake City, Utah, USA h University of California San Diego, San Diego, Calif, USA |
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Abstract: | Backgroundβ-Blockers reduce morbidity and mortality rates in heart failure (HF) clinical trials, but it is unknown whether these findings persist in the community setting.MethodsA registry was created to survey tolerability and outcomes during initiation and 1-year follow-up of β-blocker treatment with carvedilol in patients with HF treated by cardiologists (CARD) and primary care physicians (PCP) in the community.ResultsA total 4280 patients were enrolled (3121 by 259 CARD, 1159 by 129 PCP). Patient age averaged 67 ± 13 years; 35% were women and 12% were black. The left ventricular ejection fraction averaged 31 ± 12; New York Heart Association class was II-III in 86% and IV in 3%. Patients of PCP had higher left ventricular ejection fraction, were older, and more frequently were female, black, diabetic, hypertensive, and in New York Heart Association class III/IV. Minimal difficulty titrating carvedilol was noted by >80% of CARD and PCP. Significantly more CARD-treated patients reached carvedilol doses of 25 mg twice daily (49% vs 27%). Kaplan-Meier all-cause mortality rate was 8.5% at 1 year and did not differ between CARD-treated and PCP-treated patients (8.2% vs 9.3%, P = .254). At least one HF hospitalization occurred in 11% of patients during follow-up, compared with 28% in the preceding year.ConclusionsCommunity-based physicians use carvedilol with success approaching that of clinical trials. Overall mortality rates and HF hospitalizations were in the same low range as in clinical trials. Thus, it appears that results of clinical trials with carvedilol for HF can be translated to the community setting. |
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