Carvedilol decreases mortality, slightly improves QOL (COMET)

General

Clinical Question:
In patients with heart failure, is carvedilol better than metoprolol in decreasing mortality and improving quality of life?

Bottom Line:
Carvedilol (Coreg) treatment of patients with New York Heart Association (NYHA) functional class II-IV heart failure decreases mortality over 4 years more than metoprolol (number needed to treat = 18). Hospitalization rates, length of stay, and patient reports of symptoms are not different between the 2 drugs. (LOE = 1b)

Reference:
Cleland JG, Charlesworth A, Lubsen J, et al, for the COMET Investigators. A comparison of the effects of carvedilol and metoprolol on well-being, morbidity, and mortality (the "patient journey") in patients with heart failure. J Am Coll Cardiol 2006;47:1603-1611.  [PMID:16630997]

Study Design:
Randomized controlled trial (double-blinded)

Allocation:
Uncertain

Setting:
Outpatient (any)

Synopsis:
The investigators enrolled 3029 patients who had NYHA class II-IV heart failure, an ejection fraction of 35% or less, and who were on stable treatment with an angiotensin-converting enzyme inhibitor and at least 40 mg/day of furosemide. The patients were randomly assigned to receive either carvedilol (Coreg) 25 mg or metoprolol 50 mg twice daily after a slow titration, which were then continued for an average for almost 5 years. On average, carvedilol decreased heart rate, a surrogate measure of beta-blockade, slightly more than metoprolol, although its effect probably is not related to changes in heart rate (Eur Heart J 2005;26:2259-2268). The investigators evaluated 4 outcomes using intention-to-treat analysis: death and hospitalization were the primary outcomes, and symptoms and well-being were secondary outcomes. Symptoms and well-being were measured by asking patients to indicate, on a scale of 1 to 5, the answer to the question, "Over the past week, how have you been feeling?" A score of 1 was coded as 100%, with each higher number resulting in assignment of a 20% decrement in well-being score (ie, a score of 3 would be scored as a 60%).The 4 outcomes were combined into a new outcome measure called "the patient journey," which is somewhat similar to quality-adjusted life-years. During the study period, there were fewer deaths in the patients assigned to carvedilol (number needed to treat = 18; 95% CI, 11-45). Hospitalization rates and length of stay did not differ between the 2 groups. Over the 4 years, the patient journey scores in both groups decreased as more patients died and as symptoms became worse. Patient journey scores were slightly better for the patients receiving carvedilol.

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Citation

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TY - ELEC T1 - Carvedilol decreases mortality, slightly improves QOL (COMET) ID - 426238 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426238/all/Carvedilol_decreases_mortality__slightly_improves_QOL__COMET_ PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -