Effect of Carvedilol vs Metoprolol Succinate on Mortality in Heart Failure with Reduced Ejection Fraction

dc.contributor.authorAjam, Tarek
dc.contributor.authorAjam, Samer
dc.contributor.authorDevaraj, Srikant
dc.contributor.authorMohammed, Kahee
dc.contributor.authorSawada, Stephen
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2018-02-16T15:22:09Z
dc.date.available2018-02-16T15:22:09Z
dc.date.issued2018-05
dc.description.abstractBackground Beta blocker therapy is indicated in all patients with heart failure with reduced ejection fraction (HFrEF) as per current guidelines. The relative benefit of carvedilol to metoprolol succinate remains unknown. This study aimed to compare survival benefit of carvedilol to metoprolol succinate. Methods The VA’s databases were queried to identify 114,745 patients diagnosed with HFrEF from 2007 to 2015 who were prescribed carvedilol and metoprolol succinate. The study estimated the survival probability and hazard ratio by comparing the carvedilol and metoprolol patients using propensity score matching with replacement techniques on observed covariates. Sub-group analyses were performed separately for men, women, elderly, duration of therapy of more than 3 months, and diabetic patients. Results A total of 43,941 metoprolol patients were matched with as many carvedilol patients. The adjusted hazard ratio of mortality for metoprolol succinate compared to carvedilol was 1.069 (95% CI: 1.046-1.092, P value: < .001). At six years, the survival probability was higher in the carvedilol group compared to the metoprolol succinate group (55.6% vs 49.2%, P value < .001). The sub-group analyses show that the results hold true separately for male, over or under 65 years old, therapy duration more than three months and non-diabetic patients. Conclusion Patients with HFrEF taking carvedilol had improved survival as compared to metoprolol succinate. The data supports the need for furthering testing to determine optimal choice of beta blockers in patients with heart failure with reduced ejection fraction.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationAjam, T., Ajam, S., Devaraj, S., Mohammed, K., Sawada, S., & Kamalesh, M. (2018). Effect of Carvedilol vs Metoprolol Succinate on Mortality in Heart Failure with Reduced Ejection Fraction. American Heart Journal. https://doi.org/10.1016/j.ahj.2018.01.005en_US
dc.identifier.urihttps://hdl.handle.net/1805/15226
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.ahj.2018.01.005en_US
dc.relation.journalAmerican Heart Journalen_US
dc.rightsPublisher Policyen_US
dc.sourceAuthoren_US
dc.subjectheart failureen_US
dc.subjectbeta blockeren_US
dc.subjectcarvedilolen_US
dc.subjectmetoprolol succinateen_US
dc.titleEffect of Carvedilol vs Metoprolol Succinate on Mortality in Heart Failure with Reduced Ejection Fractionen_US
dc.typeArticleen_US
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