Fowler Michael
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA.
Rev Cardiovasc Med. 2002;3 Suppl 3:S20-6.
Beta-adrenergic blocking drugs have been shown to improve survival and well-being of patients with mild to moderate heart failure. In more advanced heart failure, the relationship between the short-term hemodynamic support afforded by activation of the sympathetic nervous system and the harm that results from excess sympathetic activation is more complex. Not all studies of beta-adrenergic blocking drugs or antiadrenergic therapy have shown benefit. The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial has revealed that the combined nonselective beta-adrenergic and a-adrenergic receptor blocking drug carvedilol produces an important salutary effect on the natural history of advanced heart failure. Mortality was reduced by 35% in the carvedilol group, from an annual (Kaplan-Meier) rate of 18.5% to 11.4%. All-cause hospitalizations were reduced by 20% and hospitalization from heart failure by 33%. Even amongst the subgroups at highest risk, no subpopulation could be identified that did not appear to benefit. The trial supports extending the population of those with chronic heart failure who should be routinely treated with beta-adrenergic blocking drugs (in addition to angiotensin-converting enzyme inhibition therapy) to patients with more advanced disease.
