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Evidence-Based Medicine 2007;12:141; doi:10.1136/ebm.12.5.141
Copyright © 2007 by the BMJ Publishing Group Ltd.
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Therapeutics

Carvedilol was more effective than metoprolol for preventing cardiovascular events in heart failure

Remme WJ, Torp-Pedersen C, Cleland JG, et al. Carvedilol protects better against vascular events than metoprolol in heart failure: results from COMET. J Am Coll Cardiol 2007;49:963–71.[Abstract/Free Full Text]

Q In patients with heart failure (HF), what is the relative effectiveness of carvedilol and metoprolol for preventing cardiovascular events?

Clinical impact ratings Internal medicine ******{star} Cardiology ******{star}

Key Words: adrenergic ß-antagonists • carbazoles • heart failure (congestive) • metoprolol • propanolamines

The first 150 words of the full text of this article appear below.

METHODS
Formula Design: randomised controlled trial (Carvedilol Or Metoprolol European Trial [COMET]).

Formula Allocation: {concealed}*.{dagger}

Formula Blinding: blinded {patients, healthcare providers, data collectors, outcome assessors, data analysts, and monitoring committee}*.{dagger}

Formula Follow up period: mean 58 months.

Formula Setting: {341 centres in 15 European countries}*.

Formula Patients: 3029 patients (mean age 62 y, 80% men) with stable chronic HF, left ventricular ejection fraction <=35%, and >=1 cardiovascular hospital admission in the previous year, who were being treated with an angiotensin converting enzyme inhibitor and diuretics. Exclusion criteria included important valvular disease or ventricular arrhythmias; uncontrolled hypertension; and recent myocardial infarction (MI), unstable angina, or stroke.

Formula Intervention: twice daily target doses of carvedilol, 25 mg (n = 1511), or metoprolol tartrate, 50 mg (n = 1518).

Formula Outcomes: cardiovascular events (cardiovascular death, MI, stroke, or unstable angina).

Formula Patient follow up: 100% (intention to treat analysis).

MAIN RESULTS
Carvedilol reduced the risks of overall cardiovascular events, cardiovascular death, MI, . . . [Full text of this article]

Christopher B Granger, MD

Duke Clinical Research Institute,
Durham, North Carolina, USA


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Glossary
Evid. Based Med. 2007 12: 160. (in Glossary) [Extract] [Full Text] [PDF]

Carvedilol was more effective than metoprolol tartrate for lowering mortality in chronic heart failure
Curt D Furberg and Bruce M Psaty
Evid. Based Med. 2004 9: 14. (in Therapeutics) [Extract] [Full Text] [PDF]





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