Abstract
Back ground: Little data exist to demonstrate the tolerability of β-blocker therapy in an unselected community heart failure population already treated with the clinical trial or higher dose ACEI or ARB. Methods and results: 141 patients who had left ventricular systolic failure on standard therapy were recruited in our study. Patients were assigned to receive either Carvedilol or Bisoprolol. Conclusion: This prospective observational study showed that β-blocker therapy is well tolerated and can be safely titrated in an out-patient setting.Keywords: Carvedilol, Bisoprolol.
Highlights
There is considerable data from the meta–analyses of many small trials and from CIBISII showed the beneficial role of dblocker therapy in heart failure5-7 .The modern era of large randomised controlled trials involving d-blockers really started with the US Carvedilol Heart Failure Study, in which a very substantial reduction in mortality and morbidity was shown with Carvedilol
Another study with Carvedilol was the smaller Australia- New Zealand Heart Failure Research Group Trial of around 300 patients following myocardial infarction[8]. This showed a reduction in a composite end point of hospitalizations but focused on one aspect –the effect on left ventricular function—which suggested that it was improved by Carvedilol
The follow-up of our study was one year which was equal to MERIT HF, was shorter than CIBIS II and longer than COPERNICUS and USCP
Summary
P=0.60 p=0.738 p=0.051 p=0.431 p=0.067 p=0468 p=0.419 p=0.693 p=0.516 p=0.989 p=0.67 p=0.028 p=0.001 p=0.005 p=0.666 p=0.667 p=0.221 p=0.370 p=0.187. Statistical Analysis Age , loop diuretic dose , mean systolic and diastolic blood pressure both before and after titration , mean urea pre and post titration were all compared using the Student t-Test with a p< 0.05 demonstrating a significant difference. Proportion of male to females in the study population of ACE inhibitor to ARB dose, whether nitrates, digoxin , spironolactone were administered or not , whether patients were in sinus rhythm , hypertensive or had underlying ischemia were all compared using Chi-squared test. The sample population is small (n= 141), the group was very representative of a typical heart failure population, given the fact that patients form hospital admissions, GP referrals etc were included in the study Allied to this is the fact that the only exclusion criteria were patients in whom beta-block would be contra-indicated, and those with high degree AV block
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