NYMC Faculty Publications

Effect of Carvedilol Versus Metoprolol CR/XL on Mortality in Patients with heart failure treated with cardiac resynchronization Therapy: a COX Multivariate Regression Analysis

Author Type(s)

Faculty

DOI

10.1097/MJT.0b013e3181f2abb3

Journal Title

American Journal of Therapeutics

First Page

247

Last Page

253

Document Type

Article

Publication Date

1-1-2013

Department

Medicine

Keywords

Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Carbazoles, Cardiac Resynchronization Therapy, Carvedilol, Combined Modality Therapy, Drug Administration Schedule, Female, Follow-Up Studies, Heart Failure, Humans, Male, Maximum Tolerated Dose, Metoprolol, Middle Aged, Multivariate Analysis, Propanolamines, Proportional Hazards Models, Treatment Outcome, Ultrasonography

Disciplines

Medicine and Health Sciences

Abstract

We investigated in 136 consecutive patients with heart failure receiving cardiac resynchronization therapy (CRT) the effect of carvedilol versus metoprolol CR/XL versus no beta blocker on mortality. Of the 136 patients, 42 (31%) were on carvedilol, 80 (59%) were on metoprolol CR/XL, and 14 (10%) were not on a beta blocker. A decrease of left ventricular end-systolic volume ≥15% after CRT was defined as a positive response to CRT. Of the 136 patients, 62 (46%) responded to CRT. It was found that both carvedilol and metoprolol CR/XL were not related to CRT response on using Cox univariate regression analysis. Twenty-two of the 136 patients (16%) died during follow-up of 17 ± 10 months after initiating CRT. Mortality occurred in 14 of 80 patients (18%) on metoprolol CR/XL, in 3 of 42 patients (7%) on carvedilol, and in 5 of 14 patients (36%) not on beta blockers (P = 0.04). After adjustment for age, gender, and the variables with significant differences by Cox univariate regression, both carvedilol (hazard ratio = 0.14; P = 0.03; 95% confidence interval = 0.02-0.86) and metoprolol CR/XL (hazard ratio = 0.19; P = 0.02; 95% confidence interval = 0.04-0.80) were found to be related to mortality by Cox multivariate regression.

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