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Carvedilol titration in patients with congestive heart failure receiving inotropic therapy

A Kumar1, G Choudhary, C Antonio

  • 1Michael Reese Hospital, Chicago, Ill., USA.

American Heart Journal
|August 30, 2001
PubMed

Insights

Carvedilol titration is feasible in advanced congestive heart failure (CHF) patients stabilized on milrinone. This approach can lead to reduced inotrope dependence and improved functional capacity in CHF patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Carvedilol improves outcomes in congestive heart failure (CHF).
  • Limited data exist on carvedilol use in patients receiving inotropic therapy.
  • This study examines carvedilol titration in NYHA class IIIb/IV patients stabilized on milrinone.

Purpose of the Study:

  • To assess the safety and efficacy of carvedilol titration in patients with advanced CHF stabilized on milrinone.
  • To compare outcomes of carvedilol titration between patients on milrinone and those not on inotropes.

Main Methods:

  • A nonrandomized study comparing two groups: NYHA class IIIb/IV CHF patients on milrinone (group 1) and compensated CHF patients not on inotropes (group 2).
  • Both groups were titrated on carvedilol, with success rates and adverse events monitored.
  • Patients were assessed for achievement of target carvedilol dose and changes in milrinone therapy.

Main Results:

  • Successful carvedilol titration was achieved in 88% of group 1 and 93% of group 2 patients.
  • Adverse events occurred in 47% of group 1 and 28% of group 2.
  • 53% of group 1 patients were weaned off milrinone or had reduced infusion frequency, with 63% showing improved functional class.

Conclusions:

  • Carvedilol titration is feasible in stable, advanced CHF patients on milrinone.
  • This approach may allow for reduced or eliminated inotrope use and improved functional status.
  • Further randomized trials are needed to validate the combination of milrinone and beta-blockers.
Abstract

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