Carvedilol not beneficial for children and adolescents with heart failure
Clinical QuestionIs carvedilol beneficial in the management of children and adolescents with heart failure?
Bottom LineThis study found no evidence for a benefit of carvedilol (Coreg) in the management of children and adolescents with heart failure. (LOE = 1b-)
ReferenceShaddy RE, Boucek MM, Hsu DT, et al, for the Pediatric Carvedilol Study Group. Carvedilol for children and adolescents with heart failure. A randomized controlled trial. JAMA 2007;298(10):1171-1179. [PMID:17848651]
Study DesignRandomized controlled trial (double-blinded)
SynopsisThe benefit of beta-blockade treatment for children and adolescents with heart failure is uncertain. These investigators identified 161 patients, 18 years or younger, with chronic symptomatic heart failure due to ventricular systolic dysfunction (ejection fraction < 40%). Causes of heart failure included dilated cardiomyopathy and congenital heart disease. All patients were receiving standard heart failure medications including angiotensin-converting enzyme inhibitors. Eligible patients randomly received (allocation concealment uncertain) twice-daily low-dose carvedilol (target dose = 0.2 mg/kg per dose if < 62.5 kg or 12.5 mg per dose if >= 62.5 kg), high-dose carvedilol (target dose = 0.4 mg/kg per dose or 25 mg per dose, respectively), or matched placebo. Individuals assessing outcomes remained masked to treatment group assignment. Complete follow-up occurred for 98% of patients for up to 4 years. Using intention-to-treat analysis, there were no significant differences between the treatment groups for all-cause mortality, hospitalization rates, or global assessment scores. In addition, no significant effect of age or sex on any outcomes was detected. The study was 90% powered to detect a clinically significant difference between the combined carvedilol groups and placebo.
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Barry, Henry, et al., editors. "Carvedilol Not Beneficial for Children and Adolescents With Heart Failure." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426796/all/Carvedilol_not_beneficial_for_children_and_adolescents_with_heart_failure.
Carvedilol not beneficial for children and adolescents with heart failure. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426796/all/Carvedilol_not_beneficial_for_children_and_adolescents_with_heart_failure. Accessed March 31, 2023.
Carvedilol not beneficial for children and adolescents with heart failure. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426796/all/Carvedilol_not_beneficial_for_children_and_adolescents_with_heart_failure
Carvedilol Not Beneficial for Children and Adolescents With Heart Failure [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 March 31]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426796/all/Carvedilol_not_beneficial_for_children_and_adolescents_with_heart_failure.
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TY - ELEC T1 - Carvedilol not beneficial for children and adolescents with heart failure ID - 426796 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/426796/all/Carvedilol_not_beneficial_for_children_and_adolescents_with_heart_failure PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -