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Therapeutics
Carvedilol reduced mortality and hospitalisation in severe chronic heart failure

https://doi.org/10.1136/ebm.6.6.173

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    (2001) N Engl J Med 344, 1651. Packer M, Coats AJ, Fowler MB, et al,. for the Carvedilol Prospective Randomized Cumulative Survival Study Group.. Effect of carvedilol on survival in severe chronic heart failure.. May 31;. :. –8.
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 QUESTION: In patients with severe chronic heart failure, does carvedilol, a β-blocker, reduce mortality and hospitalisation?

    Design

    Randomised {allocation concealed*}†, blinded (patients and clinicians),* placebo controlled trial with mean follow up of 10.4 months (Carvedilol Prospective Randomized Cumulative Survival Study [COPERNICUS]).

    Setting

    334 centres in 21 countries.

    Patients

    2289 patients (mean age 63 y, 80% men). Inclusion criteria were dyspnoea or fatigue at rest or on minimal exertion for ≥ 2 months; left ventricular ejection fraction ≤ 25%; absence of rales and ascites; minimal or no peripheral oedema; not hospitalised for intensive care or continued inpatient care; and no recent intravenous inotropic agents or vasodilators. Exclusion criteria included chronic heart failure caused by uncorrected primary valvular disease or reversible cardiomyopathy; recent coronary revascularisation, acute myocardial, or cerebral ischaemic event, or ventricular tachycardia or fibrillation; systolic blood pressure < 85 mm Hg; heart rate 68 beats/minute; or serum creatinine level 2.8 mg/dl. Follow up was 100%.

    Intervention

    Patients were allocated to carvedilol 3.125 g twice daily for 2 weeks, which was then titrated to 25 mg twice dailyif tolerated …

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