Carvedilol Superior to Metoprolol in Mortality Reductions for Heart Failure

SAN FRANCISCO, CA—At ACC.13, the American College of Cardiology’s 62nd Annual Scientific Session, study authors presented that carvedilol compared to metoprolol was associated with a significant reduction in heart failure hospitalizations, death, and ventricular arrhythmias.

Optimal pharmacologic therapy is considered a prerequisite to consideration for cardiac resynchronization therapy (CRT),” stated Martin Huth Ruwald, MD, from University of Rochester Medical Center, Rochester, NY. Currently, metoprolol and carvedilol are the beta-blockers most often used in the management of patients with heart failure (HF).

Dr. Ruwald and colleagues conducted a study to compare the effects of carvedilol and metoprolol in patients with HF receiving cardiac resynchronization therapy – defibrillation (CRT-D) or implantable cardioverter-defibrillator (ICD) therapy in The Multicenter Automatic Defibrillator Implantation Trial – Cardiac Resynchronization Therapy (MADIT-CRT) Trial. MADIT-CRT is the largest randomized NYHA Class I/III CRT-D that showed early intervention with CRT reduced the relative risk of all-cause mortality or first heart failure event by 57% when compared to ICD therapy (P<0.001).

The team used multivariate time-dependent Cox proportional hazard regression analyses to compare all patients receiving carvedilol or metoprolol (n=1,515) on the endpoints of hospitalizations for heart failure or death and ventricular arrhythmias.

Results showed that hospitalization for heart failure or death occurred in 30% of metoprolol patients and in 23% of carvedilol patients.  Treatment with carvedilol was associated with a 49% decreased risk of hospitalization for heart failure or death when compared to metoprolol (HR 0.7, CI 0.57-0.87; P=0.001). The risk reduction was further attenuated in the sub-group of CRT-D patients (HR 0.62, CI 0.46-0.83; P=0.001) and CRT-D patients with left bundle branch block (HR 0.51, CI 0.35-0.76; P<0.001).

Ventricular arrhythmias occurred in 26% of metoprolol patients and in 22% of carvedilol (HR 0.80, CI 0.63-1.00; P=0.050). A dose-dependent relationship with decreasing risk of hospitalization for heart failure or death was linked to carvedilol but not to metoprolol.

Dr. Ruwald also concluded that carvedilol proved a “pronounced beneficial and synergistic effect in patients with CRT-D and left bundle branch block.”