The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart Failure
New England Journal of MedicinePublished 23 May 1996Open access
Milton Packer, Michael R. Bristow, Jay N. Cohn, Wilson S. Colucci, Michael B. Fowler, Edward M. Gilbert
Citations4,656
SJR quartileQ1
SJR score19.08
SNIP13.47
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Carvedilol reduces the risk or death as well as the risk of hospitalization for cardiovascular causes in patients with heart failure who are receiving treatment with digoxin, diuretics, and an angiotensin-converting-enzyme inhibitor.
Abstract
Carvedilol reduces the risk or death as well as the risk of hospitalization for cardiovascular causes in patients with heart failure who are receiving treatment with digoxin, diuretics, and an angiotensin-converting-enzyme inhibitor.
Keywords
Medicine
Journal of the Royal Statistical Society Series B (Statistical Methodology)Regression Models and Life-Tables
39,259 Citations1972D. R. Cox
New England Journal of MedicineEffect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart Failure
8,006 Citations1991The SOLVD Investigators*
The addition of enalapril to conventional therapy significantly reduced mortality and hospitalizations for heart failure in patients with chronic congestive heart failure and reduced ejection fractions.
Journal of the American Statistical AssociationNonparametric Estimation from Incomplete Observations
7,727 Citations1958Edward L. Kaplan, Paul Meier
New England Journal of MedicineEffects of Enalapril on Mortality in Severe Congestive Heart Failure
5,077 Citations1987The Consensus Trial Study Group*
It is concluded that the addition of enalapril to conventional therapy in patients with severe congestive heart failure can reduce mortality and improve symptoms and a significant improvement in NYHA classification was observed in the enAlapril group.
BiometricsA Multiple Testing Procedure for Clinical Trials
3,349 Citations1979Peter C. O’Brien, Thomas R. Fleming
The overall size of the procedure is shown to be controlled with virtually the same accuracy as the single sample chi-square test based on N(m1 + m2) observations and the power is found to bevirtually the same.
New England Journal of MedicinePlasma Norepinephrine as a Guide to Prognosis in Patients with Chronic Congestive Heart Failure
3,116 Citations1984Jay N. Cohn, T. Barry Levine +6 more
Measurements of Hemodynamics, plasma norepinephrine, and plasma renin activity in patients with moderate to severe congestive heart failure suggest that a single resting venous blood sample showing the plasma norenphrine concentration provides a better guide to prognosis than other commonly measured indexes of cardiac performance.
New England Journal of MedicineEffect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure
2,413 Citations1986Jay N. Cohn, Donald Archibald +16 more
The data suggest that the addition of hydralazine and isosorbide dinitrate to the therapeutic regimen of digoxin and diuretics in patients with chronic congestive heart failure can have a favorable effect on left ventricular function and mortality.
British Journal of CancerDesign and analysis of randomized clinical trials requiring prolonged observation of each patient. I. Introduction and design
2,312 Citations1976Richard Peto, Malcolm C. Pike +8 more
This report is the first simple account yet published for non-statistical physicians of how to analyse efficiently data from clinical trials of survival duration, and it may be preferable to use these statistical methods to study time to local recurrence of tumour, or toStudy time to detectable metastatic spread, in addition to studying total survival.
New England Journal of MedicineEffect of Oral Milrinone on Mortality in Severe Chronic Heart Failure
2,212 Citations1991Milton Packer, Joseph R. Carver +13 more
The findings indicate that despite its beneficial hemodynamic actions, long-term therapy with oral milrinone increases the morbidity and mortality of patients with severe chronic heart failure.
The LancetBeneficial effects of metoprolol in idiopathic dilated cardiomyopathy
1,234 Citations1993Finn Waagstein, Åke Hjalmarson +8 more
In patients with idiopathic dilated cardiomyopathy, treatment with metoprolol prevented clinical deterioration, improved symptoms and cardiac function, and was well tolerated.
CirculationA randomized trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees.
1,061 Citations1994
These results confirm previous trials evidence that a progressively increasing dose of beta-blocker in severe heart failure confers functional benefit, and suggest that benefit frombeta-blockade therapy was greater for those with nonischemic cardiomyopathy.
Journal of the American College of CardiologyThe neurohormonal hypothesis: A theory to explain the mechanism of disease progression in heart failure
1,052 Citations1992Milton Packer
Observations support the formulation of a neurohormonal hypothesis of heart failure and provide the basis for the development of novel therapeutic strategies in the next decade.
The American Journal of CardiologyPlasma norepinephrine in congestive heart failure
925 Citations1978James A. Thomas, Bernard H. Marks
It is demonstrated that the plasma norepinephrine concentration is directly related to the degree of left ventricular dysfunction in patients with congestive heart failure and suggested that beta adrenergic receptors are desensitized in these patients and that this desensitization contributes to the observed alterations in myocardial contractility.
CirculationAdrenergic effects on the biology of the adult mammalian cardiocyte.
872 Citations1992Douglas L. Mann, Robert L. Kent +2 more
These results constitute the initial demonstration at the cellular level that adrenergic stimulation leads to cyclic AMP-mediated calcium overload of the cell, with a resultant decrease in synthetic activity and/or viability.
HeartEffect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy.
833 Citations1975Finn Waagstein, Å Hjalmarson +2 more
It is indicated that adrenergic beta-blocking agents can improve heart function in at lease some patients with congestive cardiomyopathy and suggested that increased catecholamine activity may be an important factor for the development of this disease.
Journal of Pharmacology and Experimental TherapeuticsCarvedilol, a new vasodilator and beta adrenoceptor antagonist, is an antioxidant and free radical scavenger.
483 Citations1992Tianli Yue, H Y Cheng +7 more
The antioxidant effect of carvedilol, a new vasodilating, beta adrenoceptor blocker was studied and compared with five other beta blockers and it is concluded that carveilol is a far more potent antioxidant than other commonly used beta blockers.
New England Journal of MedicineEffects of Vesnarinone on Morbidity and Mortality in Patients with Heart Failure
477 Citations1993Arthur M. Feldman, Michael R. Bristow +9 more
Six months of therapy with 60 mg of vesnarinone per day resulted in lower morbidity and mortality and improved the quality of life of patients with congestive heart failure, however, a higher dose of veNarinone (120 mg per day) increased mortality, suggesting that this drug has a narrow therapeutic range.
CirculationLong-term beta-blockade in dilated cardiomyopathy. Effects of short- and long-term metoprolol treatment followed by withdrawal and readministration of metoprolol.
447 Citations1989Finn Waagstein, Kenneth Caidahl +3 more
Patients with dilated cardiomyopathy had a low number of ventricular beta-adrenergic receptors compared with healthy control subjects, but long-term treatment with metoprolol caused a moderate up-regulation, which may facilitate a more normal response to sympathetic stimulation.
The LancetPROLONGATION OF SURVIVAL IN CONGESTIVE CARDIOMYOPATHY BY BETA-RECEPTOR BLOCKADE
420 Citations1979Karl Swedberg, Åke Hjalmarson +2 more
It is suggested that beta-blockade prolongs survival in patients with congestive cardiomyopathy and improved myocardial function in group ISubjects received digitalis and diuretics, but group I patients received Beta-blockers as well.
CirculationDouble-Blind, Placebo-Controlled Study of the Long-term Efficacy of Carvedilol in Patients With Severe Chronic Heart Failure
375 Citations1995Henry Krum, Jonathan Sackner‐Bernstein +12 more
Compared with the placebo group, patients in the carvedilol group showed improved cardiac performance, as reflected by an increase in left ventricular ejection fraction and stroke volume index and a decrease in pulmonary wedge pressure, mean right atrial pressure, and systemic vascular resistance.
Journal of the American College of CardiologyCarvedilol improves left ventricular function and symptoms in chronic heart failure: A double-blind randomized study
374 Citations1995Stephanie L. Olsen, Edward M. Gilbert +4 more
Long-term carvedilol therapy improves rest cardiac function and lessens symptoms in patients with heart failure and resulted in a significant reduction in heart rate and mean pulmonary artery and pulmonary capillary wedge pressures and a significant increase in stroke volume and left ventricular stroke work.
Journal of the American College of CardiologyEffects of short- and long-term carvedilol administration on rest and exercise hemodynamic variables, exercise capacity and clinical conditions in patients with idiopathic dilated cardiomyopathy
322 Citations1994Marco Metra, Matilde Nardi +2 more
Short-term carvedilol administration reduces heart rate and mean pulmonary artery and pulmonary wedge pressures, whereas it improves both long-term rest and exercise left ventricular systolic function, reduces heart failure symptoms and improves submaximal exercise tolerance in patients with idiopathic cardiomyopathy.
The American Journal of CardiologyPharmacology of carvedilol
308 Citations2004Brian R. Dulin, William T. Abraham
A number of ancillary activities, including antioxidant, anti-inflammatory, and antiapoptotic properties, contribute to the clinical efficacy of carvedilol in a broad spectrum of patient types and may also confer a range of cardioprotective benefits.
Journal of the American College of CardiologyEffect of metoprolol on myocardial function and energetics in patients with nonischemic dilated cardiomyopathy: A randomized, double-blind, placebo-controlled study
307 Citations1994Eric J. Eichhorn, Christian M. Heesch +7 more
Beta-adrenergic blocking agents, such as metoprolol, are hemodynamically and energetically beneficial in the treatment of myocardial failure and favorably alters substrate utilization.
CirculationDose-response of chronic beta-blocker treatment in heart failure from either idiopathic dilated or ischemic cardiomyopathy. Bucindolol Investigators.
274 Citations1994Michael R. Bristow, John B. O’Connell +8 more
In heart failure from systolic dysfunction, beta-blockade with bucindolol produces a dose-related improvement in and prevents deterioration of left ventricular function.
CirculationBeta-blockade with bucindolol in heart failure caused by ischemic versus idiopathic dilated cardiomyopathy.
227 Citations1991Susan Woodley, Edward M. Gilbert +8 more
It is concluded that beta-blockade may produce quantitatively different degrees of response in different kinds of heart muscle disease.
European Journal of Clinical PharmacologyThe pharmacology of carvedilol
209 Citations1990R. R. Ruffolo, M. Gellai +3 more
The data indicate that carvedilol is an antihypertensive agent that is both a β-adrenoceptor antagonist and a vasodilator, which may play a prominent role in certain peripheral vascular beds, such as the cutaneous circulation, where marked increases in blood flow are observed.
CirculationEffects of long-term monotherapy with enalapril, metoprolol, and digoxin on the progression of left ventricular dysfunction and dilation in dogs with reduced ejection fraction.
208 Citations1994Hani N. Sabbah, Hisashi Shimoyama +6 more
In dogs with reduced LVEF, long-term therapy with enalapril or metoprolol prevents the progression of LV systolic dysfunction and LV chamber dilation and does not prevent progressive LV enlargement.
Journal of the American College of CardiologyBeneficial effects of metoprolol in heart failure associated with coronary artery disease: A randomized trial
198 Citations1994Michael L. Fisher, Stephen S. Gottlieb +5 more
Cautious use of titrated metoprolol appears to be safe and beneficial when added to standard heart failure therapy in patients with dilated cardiomyopathy associated with coronary artery disease.
The American Journal of CardiologyPathophysiologic and pharmacologic rationales for clinical management of chronic heart failure with beta-blocking agents
156 Citations1993M. R. Bristow
Clinical data generated in subjects with heart failure indicate that beta-antagonist therapy exerts its physiologic and clinical effects through neurohormonal antagonism, generally analogous to angiotensin-converting enzyme inhibitors.
American Heart JournalVentricular dysfunction and necrosis produced by adrenochrome metabolite of epinephrine: Relation to pathogenesis of catecholamine cardiomyopathy
132 Citations1981John C. Yates, Robert E. Beamish +1 more
The effects of adrenochrome and other metabolites of epinephrine on the ultrastructure and contractile activity of isolated rat hearts perfused under conditions in which the heart rate and coronary flow were controlled are examined to show consistency with the concept that oxidation products of catecholamines such as Adrenochrome are partly responsible for inducing myocardial necrosis and failure following massive catechlamine injections in intact animals.
Annals of Internal MedicineThe Effect of Beta Adrenergic Blockade on Patterns of Urinary Sodium Excretion
125 Citations1966Stephen E. Epstein, EUGENE BRAUNWALD
The American Journal of CardiologyBeta-adrenergic receptor regulation and left ventricular function in idiopathic dilated cardiomyopathy
110 Citations1993Edward M. Gilbert, Stephanie L. Olsen +2 more
Chronic beta blockade may improve hemodynamic and clinical response in patients with idiopathic dilated cardiomyopathy by protecting the myocardium from the cardiotoxic effects of increased catecholamines and by up-regulating the beta 1 receptors.
Cardiovascular ResearchCardioprotective effects of carvedilol, a novel adrenoceptor antagonist with vasodilating properties, in anaesthetised minipigs: comparison with propranolol
79 Citations1992Antoine Bril, Ryan Shulman +6 more
The cardioprotective effect of carvedilol, which reduced infarct size by 91%, may result from the combined effects of beta adrenoceptor blockade and vasodilatation, and possibly also from inhibition of intracellular calcium overload in cardiac cells resulting from antagonism of myocardial alpha 1 adrenoceptors and/or calcium channel blockade.