Abstract
Previous trials (Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure [MERIT-HF], Cardiac Insufficiency Bisoprolol Study [CIBIS] II) have demonstrated a mortality benefit of β-adrenergic blockade in patients with mild to moderate heart failure. The recent Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial has extended these results to a more advanced patient population. This trial did not, however, include patients who could not reach compensation, patients with far advanced heart failure symptoms, or a significant number of black patients. Future studies of β-blockade may focus on these patients or patients with asymptomatic left ventricular dysfunction.
Highlights
Heart failure medical therapy has undergone drastic evolution in the past 15 years
As the COPERNICUS trial has only been presented orally, the results presented here are preliminary
The COPERNICUS trial recruited 2289 patients from 152 sites who were randomized to carvedilol (n = 1156) or placebo (n = 1133) and were followed for a mean of 316 days [7]
Summary
Heart failure medical therapy has undergone drastic evolution in the past 15 years. The shift in our understanding of how to optimally treat this clinical syndrome has been only slightly less dramatic than the shift in conceptual thought effected by the Polish astronomer Nicolas Copernicus (1473–1543), after whom the COPERNICUS trial is named. The theory of giving a beta-blocker, a negatively inotropic and chronotropic agent, to a heart failure patient was perhaps as counter-intuitive and revolutionary as was Copernicus’ heliocentric solar system, inasmuch as when first proposed it did not fit the accepted paradigm of the day. Inhibition of neurohormonal activation by angiotensin converting enzyme (ACE) inhibitors [2,3] or beta-blocking agents [4,5,6,7,8] has shown an attenuation or reversal in the pathological remodeling process [9,10], a shift in phenotype back towards normal [11], and even a reduction in cell death [12]. Patients with more than minimal evidence of fluid retention (pulmonary or peripheral edema) were excluded, as were patients in the intensive care unit, and patients who had recently received class IV diuretics or inotropes within 4 days
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