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Carvedilol versus controlled-release metoprolol for elderly veterans with heart failure

Thomas S Rector1, Inder S Anand, David B Nelson

  • 1Minneapolis Veterans Affairs Medical Center and Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55417, USA. thomas.rector@va.gov

Journal of the American Geriatrics Society
|April 4, 2008
PubMed

Insights

Prescribing of carvedilol and metoprolol in elderly heart failure veterans often used doses below target. Controlled-release metoprolol showed better survival than carvedilol at these doses.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • Heart failure (HF) management in elderly veterans often involves beta-blockers.
  • Carvedilol and controlled-release (CR) metoprolol are common HF treatments.
  • Optimal dosing strategies for these beta-blockers in older populations require characterization.

Purpose of the Study:

  • To analyze the prescribing patterns of carvedilol and CR metoprolol in elderly veterans with heart failure.
  • To compare the time to hospitalization or death between patients receiving carvedilol and CR metoprolol.

Main Methods:

  • Retrospective cohort study utilizing Veterans Health Administration data.
  • Inclusion of veterans diagnosed with heart failure and receiving carvedilol or CR metoprolol.
  • Cox regression analysis to estimate hazard ratios for clinical outcomes.

Main Results:

  • The majority of prescribed beta-blocker doses were below 50% of target doses.
  • No significant difference in hospitalization or death risk was observed between carvedilol and CR metoprolol (HR 0.99).
  • CR metoprolol was associated with a statistically significant lower risk of death alone (HR 0.91).

Conclusions:

  • Current beta-blocker dosing in elderly heart failure veterans is frequently sub-optimal.
  • Further research is needed to determine if increasing beta-blocker doses improves outcomes.
  • CR metoprolol demonstrated a survival benefit over carvedilol at prescribed doses, though unmeasured confounders may exist.
Abstract

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