Switching to evidence-based once-daily beta-blockers for improved adherence to medication across the continuum of post-myocardial infarction left ventricular dysfunction and heart failure.

Although adherence to evidence-based therapy has been shown to improve clinical outcomes post-myocardial infarction (MI) and in patients with heart failure, adherence remains suboptimal. One method that has demonstrated success in improving adherence is the reduction in the frequency of drug administration (eg, switching from a twice-daily to a once-daily regimen). A once-daily controlled-release (CR) formulation of carvedilol--a beta-blocker used in the treatment of post-MI left ventricular dysfunction (LVD), heart failure, and hypertension--has recently received US approval. This review provides a switching protocol for transitioning stable patients from twice-daily carvedilol to once-daily carvedilol CR. Based on the findings from a head-to-head comparison study of carvedilol and metoprolol tartrate suggesting that carvedilol is associated with superior reductions in mortality and morbidity, physicians may consider switching patients with heart failure receiving beta-blockers who have not shown benefits in this setting. Algorithms are provided for switching patients with heart failure or post-MI LVD from another beta-blocker to carvedilol CR.