Effect of Carvedilol on Morbidity and Mortality in CHF
Clinical Question
Will treatment with carvedilol in patients with CHF reduce mortality and
improve quality of life?
Clinical Bottom Line
- Carvedilol therapy reduces mortality from any cause by 59%.
- Carvedilol therapy reduced combined death or hospitalizations by 38%.
- Side effect profile is very favorable.
The Evidence
|
Risk (%) [95% CI] |
|
|
|
|
|
Placebo |
Carvedilol |
RRR* |
ARR** |
NNT*** |
| Overall Mortality |
7.8 |
3.2 |
59 |
4.6 |
22 |
| Mortality due to progressive CHF |
3.3 |
0.7 |
79 |
2.6 |
38 |
| Mortality due to sudden death |
3.8 |
1.7 |
55 |
2.1 |
48 |
Comments
- This was a well-designed study, valid according to the JAMA User guideline
on Therapeutic Article.
- An intention-to-treat analysis was employed.
- The study was halted early because of the significant benefit in the
carvedilol group.
- Confidence intervals were not supplied for the absolute risk reductions,
but were for the relative risk reductions.
- Only 22 patients need to be treated to prevent one death.
- The effect was the same when adjusted for age, sex, ejection fraction,
heart rate, SBP, exercise tolerance, etc.
- All clinically important outcomes were considered.
- Patients were excluded from the study if they had any comorbidities that
would restrict exercise tolerance or mortality. In practice, this would also
exclude the majority of patients. However, the benefit afforded by carvedilol's
use in that select group of patients could most likely be seen in patients with
other co-morbidities.
APPRAISED BY: Lai Chow Kok, MD
DATE: July 15, 1996
REVIEWED BY: Patrick J. Sousa, MD
Packer M, et al. The Effect of Carvedilol on Morbidity and Mortality
in Patients with Chronic Heart Failure. NEJM, 1996;334:1349-1355.
