Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction

Tarek Ajam, Samer Ajam, Srikant Devaraj, Kahee Mohammed, Stephen Sawada, Masoor Kamalesh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Beta blocker therapy is indicated in all patients with heart failure with reduced ejection fraction (HFrEF) as per current guidelines. The relative benefit of carvedilol to metoprolol succinate remains unknown. This study aimed to compare survival benefit of carvedilol to metoprolol succinate. Methods: The VA's databases were queried to identify 114,745 patients diagnosed with HFrEF from 2007 to 2015 who were prescribed carvedilol and metoprolol succinate. The study estimated the survival probability and hazard ratio by comparing the carvedilol and metoprolol patients using propensity score matching with replacement techniques on observed covariates. Sub-group analyses were performed separately for men, women, elderly, duration of therapy of more than 3 months, and diabetic patients. Results: A total of 43,941 metoprolol patients were matched with as many carvedilol patients. The adjusted hazard ratio of mortality for metoprolol succinate compared to carvedilol was 1.069 (95% CI: 1.046-1.092, P value: <.001). At six years, the survival probability was higher in the carvedilol group compared to the metoprolol succinate group (55.6% vs 49.2%, P value <.001). The sub-group analyses show that the results hold true separately for male, over or under 65 years old, therapy duration more than three months and non-diabetic patients. Conclusion: Patients with HFrEF taking carvedilol had improved survival as compared to metoprolol succinate. The data supports the need for furthering testing to determine optimal choice of beta blockers in patients with heart failure with reduced ejection fraction.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalAmerican Heart Journal
Volume199
DOIs
StatePublished - May 1 2018

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Metoprolol
Heart Failure
Mortality
Survival
carvedilol
Propensity Score
Therapeutics
Databases
Guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction. / Ajam, Tarek; Ajam, Samer; Devaraj, Srikant; Mohammed, Kahee; Sawada, Stephen; Kamalesh, Masoor.

In: American Heart Journal, Vol. 199, 01.05.2018, p. 1-6.

Research output: Contribution to journalArticle

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AU - Mohammed, Kahee

AU - Sawada, Stephen

AU - Kamalesh, Masoor

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N2 - Background: Beta blocker therapy is indicated in all patients with heart failure with reduced ejection fraction (HFrEF) as per current guidelines. The relative benefit of carvedilol to metoprolol succinate remains unknown. This study aimed to compare survival benefit of carvedilol to metoprolol succinate. Methods: The VA's databases were queried to identify 114,745 patients diagnosed with HFrEF from 2007 to 2015 who were prescribed carvedilol and metoprolol succinate. The study estimated the survival probability and hazard ratio by comparing the carvedilol and metoprolol patients using propensity score matching with replacement techniques on observed covariates. Sub-group analyses were performed separately for men, women, elderly, duration of therapy of more than 3 months, and diabetic patients. Results: A total of 43,941 metoprolol patients were matched with as many carvedilol patients. The adjusted hazard ratio of mortality for metoprolol succinate compared to carvedilol was 1.069 (95% CI: 1.046-1.092, P value: <.001). At six years, the survival probability was higher in the carvedilol group compared to the metoprolol succinate group (55.6% vs 49.2%, P value <.001). The sub-group analyses show that the results hold true separately for male, over or under 65 years old, therapy duration more than three months and non-diabetic patients. Conclusion: Patients with HFrEF taking carvedilol had improved survival as compared to metoprolol succinate. The data supports the need for furthering testing to determine optimal choice of beta blockers in patients with heart failure with reduced ejection fraction.

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