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THURSDAY, July 3, 2003 (HealthDayNews) -- A newer member of the beta blocker drug family saves more lives of patients with heart failure than an older version does, a major European study finds.
In the study, which enlisted more than 3,000 heart failure patients in seven countries, the death rate over a five-year period for patients given the newer drug, carvedilol, was 5.7 percent lower than for those treated with an older beta blocker, metoprolol, says a report in the July 5 issue of The Lancet.
Extrapolating from the study results, the researchers estimate that patients on carvedilol survived for an average of eight years, compared to 6.6 years for those on metoprolol, the report says. There was no difference in the incidence of side effects, which was low.
The report not only solidifies the value of beta blocker treatment for heart failure, in which the heart gradually loses its ability to pump blood, but also "suggests that carvedilol may be a superior drug," says Dr. Richard A. Stein, associate chairman of medicine at Beth Israel Hospital in New York City and a spokesman for the American Heart Association.
"It is now clear that beta blockers are now the standard of treatment for heart failure in which the ventricle does not have an adequate ejection fraction," Stein says.
The left ventricle is the chamber of the heart that pumps blood to the body, and the ejection fraction is the amount of blood it can pump. An estimated 5 million Americans have heart failure, and about 60 percent have this form of the condition. More than 550,000 new cases are diagnosed each year, the American Heart Association estimates, and heart failure plays a role in some 260,000 deaths a year.
Stein's slight note of caution about carvedilol reflects lingering medical conservatism. He says he uses the drug regularly to treat heart failure in his practice, in a standard combination drug treatment that can include a diuretic, an ACE inhibitor and digitalis.
Beta blockers have emerged as a treatment for heart failure only in the last few years, a development that took many cardiologists by surprise. The condition has traditionally been treated with drugs that stimulate the activity of the heart, while beta blockers slow the heart rate.
"It's counter-intuitive," Stein says, but several studies have shown that starting with a low dose of a beta blocker and gradually increasing it can help keep patients alive.
Cost is a potential issue. Carvedilol, marketed as Coreg, is expensive compared to metoprolol, often sold as Toprol-XL, which is available as a generic. But the extra money is worth it, Stein says.
"A typical heart failure patient will have 1.8 hospital admissions a year, and the average cost of an admission is $20,000," he says. "If you can reduce the number of admissions, the cost of the drug is beside the point."
So far, no medical insurance plan has objected to the use of carvedilol, he adds.
Another report by British researchers in the same issue of the journal suggests carvedilol works by activating heart muscles that are healthy but "hibernating."
More information
You can learn about heart failure from the American Heart Association or the Texas Heart Institute.
