Is Real World Use of Carvedilol in Patients with HFrEF Consistent with Clinical Trial Data? A 21-Year Experience in a Private Cardiologist's

Carvedilol has been approved for treatment of New York Heart Association (NYHA) Class I, II, III and IV patients and post-Myocardial Infarction (MI) patients, if the patient's Ejection Fraction (EF) is less than 40% because this third-generation beta-blocker demonstrated a decrease in mortality. While clinical trials demonstrated the survival benefits of carvedilol, translating carvedilol's efficacy and usefulness in clinical practice requires understanding of its side effect profile and the importance of dosage and long-term monitoring.A database on use of carvedilol in a private cardiologist's practice was begun in 1997 and concluded at the end of 2018.We report analysis of 642 patients with HFrEF. Initial EF's ranged between 8 and 47% with mean EF 32 ± 6%. The average age of the patient when started on carvedilol was 69 ± 7 years. Only 7 patients were changed to metoprolol succinate because of adverse side effects. After up-titration of carvedilol, the average resting heart rate was 61 ± 8 beats per minute. Two hundred and forty patients with HFrEF on carvedilol for greater than 5 years had a significant mean increase in EF of 5.5 ± 8% (p < 0.05). Two hundred of the patients with HFrEF also had or developed type 2 diabetes and chronic kidney disease during followup. Thirty-one percent of these patients with type 2 diabetes and chronic kidney disease lived longer than 10 years. Carvedilol remains a well-tolerated beta-blocker which demonstrates long-term benefits in a real-world setting.