Division of Cardiology, Pharmacy Department, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, Madrid, Spain.
J Cardiovasc Med (Hagerstown). 2010 May;11(5):352-8. doi: 10.2459/JCM.0b013e328334f48b.
The safety of rapid carvedilol up-titration in patients with depressed left ventricular ejection fraction (LVEF) is unknown. The aim of the present work was to assess whether carvedilol can be used safely and rapidly up-titrated before hospital discharge in patients with left ventricular systolic dysfunction, with or without heart failure symptoms.
We studied 611 patients with LVEF less than 0.4 in whom carvedilol was used during hospital admission.
Mean age was 66 years, 23% were women and 372 had symptoms of heart failure. Carvedilol was initiated 3 days after admission (median); 594 patients (97%) were discharged alive, 27 (5%) without beta-blockers. Carvedilol up-titration during admission was performed in 65%. The mean time of up-titration was 1 week, with a mean increase of 16 mg/day. The discharge dose was higher in younger patients and in those weighing more than 70 kg. Only 30 patients (5%) were re-admitted during the first month after discharge. At the end of follow-up (mean 2.3 years), 497 patients were alive and transplant-free (81%). Carvedilol mean daily dose at the end of follow-up was 32.4 +/- 22.2 mg and was related to the discharge dose. The absence of beta-blocker treatment at discharge was the most important independent predictor of long-term mortality (hazard ratio 3.1, 95% confidence interval 1.5-6.2, P = 0.002).
Carvedilol up-titration is well tolerated in patients hospitalized with depressed LVEF, with or without heart failure, with a high compliance rate at discharge and in the long term.
快速加量卡维地洛在左心室射血分数（LVEF）降低的患者中的安全性尚不清楚。本研究旨在评估在伴有或不伴有心力衰竭症状的左心室收缩功能障碍患者中，卡维地洛能否在住院期间安全且快速地加量滴定。
我们研究了 611 例 LVEF 小于 0.4 的患者，这些患者在住院期间使用了卡维地洛。
平均年龄为 66 岁，23%为女性，372 例有心力衰竭症状。卡维地洛在入院后第 3 天（中位数）开始使用；594 例（97%）患者存活出院，27 例（5%）未使用β受体阻滞剂。住院期间进行了卡维地洛的滴定加量，占 65%。平均加量时间为 1 周，平均每天增加 16mg。年轻患者和体重超过 70kg 的患者的出院剂量更高。出院后第一个月内仅 30 例（5%）再次住院。随访结束时（平均 2.3 年），497 例患者存活且未进行心脏移植（81%）。随访结束时卡维地洛的平均日剂量为 32.4±22.2mg，与出院剂量相关。出院时未使用β受体阻滞剂是长期死亡率的最重要独立预测因素（风险比 3.1，95%置信区间 1.5-6.2，P=0.002）。
伴有或不伴有心力衰竭的 LVEF 降低的住院患者可耐受卡维地洛的加量滴定，出院时及长期的依从性较高。
