Transcript Document

Adrenergic blockade – clinical
update on treatment of heart
failure patients
Chairperson: W. J. Remme, Utrecht, The Netherlands
Key points from Part I
 Heart failure is the endstage of a continuum from
risk factors to left ventricular dysfunction
 Adrenergic activation plays a crucial role at all
stages of the cardiovascular continuum
 Peripheral vasoconstriction is important in heart
failure, producing negative effects on metabolic
and haemodynamic parameters
 The additional a receptor-mediated vasodilation
seen with carvedilol offsets the negative effects of
unopposed b blockade
Key points from Part I
 Despite recent advances in post-MI treatment,
there is a strong need for data to examine the role
of b blockade in post-MI patients with LVD
 The CAPRICORN trial in post-MI patients with LVD
(with or without evidence of heart failure) is now
complete and data will be presented later this year
b blockade in HF –
All-cause mortality
US Carvedilol Programme
Survival
1.0
Carvedilol
(n=696)
0.9
Placebo
(n=398)
0.8
Risk reduction = 65%
p<0.001
0.7
Survival
CIBIS-II
1.0
0.6
Bisoprolol
0.5
0 50 100 150 200 250 300 350 400
Days
0.8
Packer et al (1996)
Mortality %
20
Risk reduction = 34%
p<0.0001
0.6
0
0
200
400
MERIT-HF
Placebo
600
Placebo
15
Metoprolol CR/XL
800
10
Time after inclusion (days)
Risk reduction = 34%
p=0.0062
5
CIBIS II Investigators (1999)
0
0
3
6
9
12
15
18
21
Months of follow-up
The MERIT-HF Study Group (1999)
Current issues with b blockade in heart failure
 Are b blockers effective in:
– special populations
– left ventricular dysfunction post-MI
(CAPRICORN)
 Are there differences between
b blockers? (COMET)
 Is there a role for b blockade in severe
heart failure (COPERNICUS)
Adrenergic blockade – clinical update on
treatment of heart failure patients
Antiadrenergic therapy in mild to moderate chronic
heart failure – Are there differences between b blocking drugs ?
M Fowler
Antiadrenergic therapy in severe chronic heart failure
– Previous clinical trial evidence
H Krum
Antiadrenergic therapy in severe chronic heart failure
– The COPERNICUS trial
M Packer
Conclusions
L Rydén