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Rapid carvedilol up-titration in hospitalized patients with systolic heart failure

Manuel Martínez-Sellés1, Tomás Datino, Marta Alhama

  • 1Division of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain. mmselles@secardiologia.es

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|July 29, 2008
PubMed

Insights

Up-titrating carvedilol before hospital discharge is safe for patients with systolic heart failure. A majority of patients tolerated dose increases, achieving higher maintenance doses for improved outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Systolic heart failure (SHF) management often involves beta-blockers like carvedilol.
  • Optimizing carvedilol dosage is crucial for patient outcomes.
  • Early medication titration before discharge can improve treatment efficacy.

Purpose of the Study:

  • To assess the safety and feasibility of up-titrating carvedilol dosage in patients with SHF prior to hospital discharge.
  • To evaluate the achieved carvedilol doses at discharge and during follow-up.

Main Methods:

  • Retrospective study of 372 consecutive patients with SHF treated with carvedilol.
  • Analysis of carvedilol initiation timing, starting dose, and up-titration frequency.
  • Comparison of discharge daily doses with mean daily doses at follow-up.

Main Results:

  • Carvedilol was initiated a median of 3 days post-admission at a mean dose of 12 mg.
  • Up-titration occurred in 67% of patients, increasing the mean dose by 16 mg.
  • Mean discharge dose was 23 +/- 17 mg, increasing to 35.3 +/- 25.3 mg at follow-up.

Conclusions:

  • Up-titration of carvedilol before hospital discharge is a safe and feasible strategy in systolic heart failure patients.
  • Higher discharge doses of carvedilol were associated with increased maintenance doses and potentially better long-term management.

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