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Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
Tobias Schupp1, Michael Behnes1, Mohammad Abumayyaleh1
1First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Insights
Carvedilol and metoprolol show similar survival rates for patients with ventricular tachyarrhythmias. However, carvedilol use was linked to a higher risk of arrhythmic events compared to metoprolol.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta-blockers (BBs) are crucial in managing ventricular tachyarrhythmias (VT/VF).
- Carvedilol and metoprolol are commonly used BBs, but their comparative prognostic roles in VT/VF patients are not fully elucidated.
Purpose of the Study:
- To compare the prognostic impact of carvedilol versus metoprolol in patients experiencing ventricular tachyarrhythmias.
- To evaluate differences in all-cause mortality, arrhythmic events, and rehospitalization rates between the two BBs.
Main Methods:
- Retrospective analysis of a large patient registry (2002-2015) with VT/VF episodes on BB treatment.
- Comparison of carvedilol versus metoprolol groups using Kaplan-Meier curves, multivariable Cox regression, and propensity score matching.
- Primary outcome: 3-year all-cause mortality. Secondary outcomes: composite arrhythmic endpoint and cardiac rehospitalization.
Main Results:
- Carvedilol use (20%) was associated with older patients, more VT, and advanced heart failure compared to metoprolol (80%).
- No significant difference in 3-year all-cause mortality between carvedilol and metoprolol (HR=1.229, p=0.235).
- Carvedilol was linked to significantly higher rates of composite arrhythmic events (32% vs 17%, p=0.001) and cardiac rehospitalization (25% vs 14%, p=0.001) in unmatched analysis, persisting for arrhythmic events post-propensity score matching.
Conclusions:
- Carvedilol and metoprolol offer comparable long-term survival for patients with ventricular tachyarrhythmias.
- Carvedilol therapy is associated with an increased risk of arrhythmic events in this patient population.
- Further research into BB selection for VT/VF management is warranted.
Abstract:
The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients on beta-blocker (BB) treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with carvedilol were compared to patients with metoprolol. The primary prognostic outcome was all-cause mortality at three years. Secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies) and cardiac rehospitalization. Kaplan-Meier survival curves, multivariable Cox regression analyses, and propensity score matching were applied for statistics. There were 1098 patients included, 80% treated with metoprolol and 20% with carvedilol. Patients with carvedilol were older, more often presenting with VT (78% vs. 62%; p = 0.001) and with more advanced stages of heart failure. Treatment with carvedilol was associated with comparable all-cause mortality compared to metoprolol (20% vs. 16%, log rank p = 0.234; HR = 1.229; 95% CI 0.874-1.728; p = 0.235). However, secondary endpoints (i.e., composite arrhythmic endpoint: 32% vs. 17%; p = 0.001 and cardiac rehospitalization: 25% vs. 14%; p = 0.001) were more frequently observed in patients with carvedilol, which was still evident after multivariable adjustment. After propensity score matching (n = 194 patients with carvedilol and metoprolol), no further differences regarding the distribution of baseline characteristics were observed. Within the propensity-score-matched cohort, higher rates of the composite arrhythmic endpoint were still observed in patients treated with carvedilol, whereas the risk of cardiac rehospitalization was not affected by the type of beta-blocker treatment. In conclusion, carvedilol and metoprolol are associated with comparable all-cause mortality in patients with ventricular tachyarrhythmias, whereas the risk of the composite arrhythmic endpoint was increased in patients with carvedilol therapy.
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