Bisoprolo vs.Carvedilol: A Comparison of Clinical Efficacy and Tolerability in Congestive Cardiac Failure
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Objective: There has been no head to head comparison of the clinical outcomes between bisoprolol and carvedilol, the two beta blockers most commonly used to treat congestive heart failure in Australia. There is good evidence to support the use of either agent in the setting of CHF with significant mortality and morbidity benefits. There are some fundamental differences in the pharmacological properties, mechanisms of action and dosing regimens between the two agents. Our aim was to compare the clinical outcomes and tolerability of the two agents in the management of patients with CHF. Design and Setting: Retrospective, matched, dual parallel group analysis at a community based multi-disciplinary heart failure program. Data extraction was done by chart review. Participants: Cohort of 132 patients with heart failure (NYHA functional classes II-III, aged 28-97 years) receiving bisoprolol (n=66) or carvedilol (n=66). Main outcome measures: All-cause mortality, re-hospitalisation rates for cardiovascular reasons, change in heart rate, change in systolic blood pressure, change in diastolic blood pressure, change in left ventricular anatomy and function as measured by left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), and left ventricular end diastolic diameter (LVEDD) and change in New York Heart Association (NYHA) functional class over a period of 12 months since the initiation of therapy. Results: Heart rate, systolic diastolic blood pressure, LVEF, LVEDD and LVESD at baseline and after 12 months were comparable in both groups. Re-hospitalisation rates for cardiovascular reasons, however, were significantly lower in patients receiving carvedilol (1.6ᰮ7) vs (2.2ᱮ1) (p <0.001). All-cause mortality appeared lower in the carvedilol group, 6 (9.1%) vs 13 (19.7%), but this parameter did not reach statistical significance (p =0.083). There was a statistically significant drop in the systolic blood pressure in the carvedilol group after 12 months (132ᴲ mmHg) vs (114ᱵ mmHg) (p<0.001). Conclusions: Clinical outcomes and tolerability were comparable between carvedilol and bisoprolol in the treatment of patients with CHF. However therapy with carvedilol was associated with a significantly lower rehospitalisation rate for cardiovascular reasons and a trend towards a lower mortality rate that did not reach statistical significance. These findings support the need for a prospective, randomised controlled trial comparing bisoprolol and carvedilol in the management of patients with NYHA class II-III CHF to better identify the differences in clinical outcomes and tolerability.
Australasian Medical Journal
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Medical Physiology not elsewhere classified