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Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction

Tarek Ajam1, Samer Ajam2, Srikant Devaraj3

  • 1Saint Louis University School of Medicine, Saint Louis, MO.

American Heart Journal
|May 15, 2018
PubMed

Insights

Carvedilol improved survival in heart failure with reduced ejection fraction (HFrEF) patients compared to metoprolol succinate. This suggests carvedilol may be a superior beta blocker choice for HFrEF management.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Beta blocker therapy is standard for heart failure with reduced ejection fraction (HFrEF).
  • The comparative survival benefits of carvedilol versus metoprolol succinate in HFrEF are not well-established.
  • Current guidelines recommend beta blockers, but drug-specific efficacy requires further elucidation.

Purpose of the Study:

  • To compare the survival benefits of carvedilol against metoprolol succinate in patients with HFrEF.
  • To analyze mortality risk associated with these two common beta blockers.
  • To investigate subgroup differences in treatment efficacy.

Main Methods:

  • Utilized VA databases to identify 114,745 HFrEF patients (2007-2015).
  • Employed propensity score matching with replacement for robust comparison of carvedilol and metoprolol succinate cohorts.
  • Conducted subgroup analyses for sex, age, therapy duration, and diabetes status.

Main Results:

  • Propensity score matching yielded 43,941 pairs for analysis.
  • Metoprolol succinate was associated with a significantly higher adjusted hazard ratio for mortality (1.069) compared to carvedilol (P < .001).
  • Six-year survival probability was higher with carvedilol (55.6%) versus metoprolol succinate (49.2%) (P < .001), consistent across subgroups.

Conclusions:

  • Carvedilol demonstrated improved survival outcomes in HFrEF patients compared to metoprolol succinate.
  • These findings support carvedilol as a potentially more effective beta blocker for HFrEF.
  • Further research is warranted to confirm optimal beta blocker selection in HFrEF.
Abstract

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