Update in Cardiology

Heart Failure

Severalrecent trials have confirmed the value of β-blockers and showed that internal defibrillation and ventricular resynchronization significantly reduce mortality in post–myocardial infarction (MI) patients. However, physicians should not allow these new developments to distract them from adhering to proven treatments for patients with heart failure. A recent study of 180 community hospitals nationwide showed that drugs of proven effectiveness in reducing heart failure mortality, such as β-blockers, were not being used in many patients with heart failure.

Carvedilol Reduced MI in Patients with Previous Acute MI and Left Ventricular Systolic Dysfunction

In recent years, major randomized clinical trials—including the CIBIS II trial (Cardiac Insufficiency Bisoprolol Trial II) using bisoprolol, the MERIT-HF (the Metoprolol CR/XL Randomized Intervention Trail in congestive heart failure) trial using metoprolol (controlled release/extended release), and the COPERNICUS (Carvedilol Prospective Randomised Cumulative Survival) trial using carvedilol—have shown that β-blockers dramatically improve survival in patients with class II to IV heart failure. The trials showed efficacy in women as well as men, African Americans as well as whites, and older patients as well as younger patients. The trial investigators concurred on a dosing protocol that started with a very low dose and doubled the dose every 2 weeks until the maximum dose was reached. The recent CAPRICORN (Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction) trial was the first to provide evidence about the effect of β-blockers in class I patients (left ventricular dysfunction and significant myocardial damage but no clinical congestive heart failure).

The CAPRICORN investigators enrolled 1959 patients with a recent acute MI and left ventricular ejection fraction of 0.4 or less and randomly assigned them to receive carvedilol (n = …