Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: An analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)

Fonarow, Gregg C.; Abraham, William T.; Albert, Nancy M.; Stough, Wendy Gattis; Gheorghiade, Mihai; Greenberg, Barry H.; O'Connor, Christopher M.; Sun, Jie Lena; Yancy, Clyde; Young, James B.; on behalf of the OPTIMIZE-HF Investigators and Coordinators,

doi:10.1016/j.ahj.2006.10.008

« Previous Next »American Heart Journal
Volume 153, Issue 1 , Pages 82.e1-82.e11, January 2007

Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: An analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)

Gregg C. Fonarow, MD
- Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA
- Reprint requests: Gregg C Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, CA 90095-1679.
William T. Abraham, MD
- Division of Cardiology, Ohio State University, Columbus, OH
Nancy M. Albert, RN, PhD
- Division of Nursing and George M and Linda H Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, OH
Wendy Gattis Stough, PharmD
- Department of Medicine, Duke University Medical Center, Durham, NC
- Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, NC
Mihai Gheorghiade, MD
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
Barry H. Greenberg, MD
- Department of Medicine, USCD Medical Center-Hillcrest, University of California, San Diego, CA
Christopher M. O'Connor, MD
- Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, NC
Jie Lena Sun, MS
- Duke Clinical Research Institute, Durham, NC
Clyde Yancy, MD
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX
James B. Young, MD
- Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, OH
on behalf of the OPTIMIZE-HF Investigators and Coordinators

Received 1 August 2006; accepted 11 October 2006.

Guest Editor of this manuscript is Hector O. Ventura, MD.

Background

The IMPACT-HF trial demonstrated that carvedilol use at the time of heart failure (HF) hospital discharge significantly increased 90-day postdischarge treatment rates. Whether there is an early survival benefit associated with this therapeutic approach in patients hospitalized for HF is unknown. We examined the early effects on mortality and rehospitalization of carvedilol use at discharge in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) compared with outcomes in patients who are eligible for, but do not receive, β blockers before discharge.

Methods

The OPTIMIZE-HF program enrolled 5791 patients admitted with HF in a web-based registry at 91 hospitals participating with prespecified 60- to 90-day follow-up from March 2003 to December 2004. Outcomes data were prospectively collected on patients eligible for β-blocker therapy and analyzed according to predischarge β-blocker use.

Results

The mean age was 69.7 years; 63% were male, etiology was ischemic in 52%, and mean left ventricular ejection fraction was 24.3%. A total of 2720 patients had LVSD, among whom 2373 (87.2%) were eligible to receive a β blocker at discharge and carvedilol was prescribed in 1162 (49.0%). Discharge use of carvedilol was associated with a significant reduction in mortality risk at 60 to 90 days (hazard ratio 0.46, P = .0006) and mortality or rehospitalization (odds ratio 0.71, P = .0175) compared to no predischarge β blocker. Predischarge use of carvedilol was well tolerated with high rates of continued therapy at 60 to 90 days follow-up. Similar findings were observed for other evidence-based β blockers.

Conclusions

Carvedilol use at the time of HF hospital discharge is well tolerated, improves treatment rates, and is associated with an early survival benefit. These findings provide further support for guideline recommendations that carvedilol or other evidence-based β blocker should be initiated before hospital discharge in stable patients with HF and LVSD.