New Studies on Heart Failure

Ivanhoe Newswire

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(Ivanhoe Newswire) -- Two new studies shed some light on the treatment of heart failure. The studies, both published in The Lancet, examine the effect of beta blockers on heart failure. The first trial, COMET, compared the effects of the medications carvedilol and metoprolol.

The COMET trial involved more than 3,000 patients. All had chronic heart failure and had been hospitalized at some time for heart problems. The mortality rate for patients on carvedilol was 34 percent compared to 40 percent for patients on metoprolol. Side effects and drug withdrawals were the same between the two medications. Overall, the researchers report carvedilol extends survival compared to metoprolol.

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The second trial, CHRISTMAS, focuses on the effect of carvedilol on the myocardium the middle layer of the heart muscle. It is not well understood why beta blockers offer protection against heart failure and sudden death. However, doctors suspect they may work by increasing the left-ventricular ejection fraction (LVEF). This study looked to see how the heart muscle is involved.

Doctors enrolled 387 patients into the study. Participants were divided into two groups -- those with healthy heart muscle and those with heart muscle that does not contract. The LVEF did not change in either group when left untreated. In patients taking carvedilol, the LVEF increased. Doctors even observed improvement in the heart muscle for one to two years after treatment with the beta blocker.

The researchers write, "[Beta blockers] should now be used routinely, unless contraindicated, for all patients with heart failure due to left-ventricular systolic dysfunction." Doctors say both of these studies are important because far too few patients are being given beta blockers to protect against heart failure.

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SOURCE: The Lancet, 2003;362:7-21