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Bucindolol reduced mortality and hospitalisation related to cardiovascular causes in advanced chronic heart failure
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 QUESTION: In patients with advanced chronic heart failure, does bucindolol reduce all-cause mortality, cardiovascular mortality, and hospitalisation for chronic heart failure?

Design

Randomised (allocation concealed*), blinded (clinicians and patients),* placebo controlled trial with mean follow up of 2 years (Beta-Blocker Evaluation of Survival Trial [BEST]).

Setting

90 clinical sites in the USA and Canada.

Patients

2708 patients (mean age 60 y, 78% men). Inclusion criteria were New York Heart Association (NYHA) class III or IV chronic heart failure caused by primary or secondary dilated cardiomyopathy; left ventricular ejection fraction ≤ 35%; optimal medical treatment, including angiotensin-converting enzyme inhibitors for ≥ 1 month; and ≥ 18 years of age. Exclusion criteria included reversible heart failure; uncorrected primary valvular disease; active myocarditis; recent myocardial infarction or revascularisation; unstable angina; heart rate < 50 beats/minute; or serious concomitant illness.

Intervention

Patients were allocated to bucindolol, 3 mg twice daily for 1 week, which was then titrated gradually to a maximum dose of 100 mg twice daily (n=1354) or to placebo (n=1354).

Main outcome measures

All-cause mortality, cardiovascular mortality, and hospitalisation related to chronic heart …

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