Carvedilol Versus Controlled-Release Metoprolol for Elderly Veterans with Heart Failure

• Autores: Thomas S. Rector, Inder S. Anand, David B. Nelson, Kristine E. Ensrud
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 56, Nº. 6, 2008, págs. 1021-1027
• Idioma: inglés
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• Resumen

  • OBJECTIVES: To characterize prescribing of carvedilol and controlled-release (CR) metoprolol for veterans with heart failure who were predominantly elderly (aged \u226565) and to compare the time to first hospitalization or death.

    DESIGN: Retrospective cohort.

    SETTING: Veterans Health Administration (VHA) nationwide healthcare system.

    SUBJECTS: Veterans enrolled in fee-for-service Medicare that had a VHA diagnosis of heart failure and a first prescription for carvedilol (n=17,429) or CR metoprolol (n=8,683) between October 1999 and September 2003.

    MEASUREMENTS: Prescribed daily doses and CR metoprolol-to-carvedilol hazard ratios (HRs) estimated using Cox regression within strata defined according to propensity to prescribe carvedilol.

    RESULTS: After several months, the majority of prescribed doses in both cohorts were less than 50% of target doses. The risk-adjusted HR was 0.99 (95% confidence interval=0.96\u20131.03) for hospitalization or death and 0.91 (0.85\u20130.96) for death alone.

    CONCLUSION: Doses of beta-blockers being prescribed to predominantly elderly veterans with heart failure were much lower than proven doses. Whether efforts to increase doses can improve the effectiveness of beta-blocker therapy warrants further study. At the prescribed doses, CR metoprolol was associated with better survival than carvedilol, although unmeasured confounding variables might explain the observed difference in survival.