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Beta-blocker therapy for heart failure outside the clinical trial setting: findings of a community-based registry

Joseph A Franciosa1, Barry M Massie, Mary Ann Lukas

  • 1Mount Sinai School of Medicine and Weill Medical College, Cornell University, New York, NY, USA. JosephAFranciosa@aol.com

American Heart Journal
|October 2, 2004
PubMed

Insights

Beta-blocker (carvedilol) treatment for heart failure (HF) in the community setting showed outcomes similar to clinical trials. This indicates that HF management guidelines can be successfully applied by primary care physicians and cardiologists.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Beta-blockers are proven to reduce morbidity and mortality in heart failure (HF) clinical trials.
  • Evidence for beta-blocker effectiveness in real-world community settings is less understood.

Purpose of the Study:

  • To assess the tolerability and outcomes of carvedilol initiation in community-based heart failure patients.
  • To compare outcomes between cardiology and primary care physician management.

Main Methods:

  • A registry collected data on 4280 heart failure patients initiating carvedilol.
  • Follow-up included 1-year assessment of tolerability, dosing, mortality, and HF hospitalizations.
  • Patients were managed by either cardiologists (CARD) or primary care physicians (PCP).

Main Results:

  • Over 80% of patients experienced minimal difficulty with carvedilol titration.
  • Cardiologist-managed patients were more likely to reach target carvedilol doses (49% vs 27%).
  • One-year all-cause mortality was 8.5%, with no significant difference between CARD and PCP groups (8.2% vs 9.3%).
  • HF hospitalizations decreased from 28% in the prior year to 11% during follow-up.

Conclusions:

  • Community-based carvedilol use in heart failure is successful, with outcomes comparable to clinical trials.
  • Results suggest that clinical trial findings for carvedilol in HF can be effectively translated to community practice.
  • Both cardiologists and primary care physicians can achieve favorable outcomes with carvedilol in heart failure management.
Abstract

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