Predicting response to carvedilol for the treatment of heart failure: A multivariate retrospective analysis

Schleman, Kimberly Anne; Lindenfeld, Jo Ann; Lowes, Brian D.; Bristow, Michael R.; Ferguson, Debra A.; Wolfel, Eugene E.; Abraham, William T.; Zisman, Lawrence S.

doi:10.1054/jcaf.2001.22491

Cited by 25 publications

(11 citation statements)

References 21 publications

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“…This finding is in line with other studies that have reported that change in heart rate is correlated with improvements in survival and ejection fraction [25,26]. Schleman et al [26] speculated that patients with higher baseline heart rate have a greater degree of cardiac adrenergic activation and that heart rate may serve as a surrogate marker of adrenergic drive. Overall, carvedilol was well tolerated by our patients and the rate of discontinuation was low.…”

Section: Discussionsupporting

confidence: 88%

Impact of a Standardized Titration Protocol with Carvedilol in Heart Failure: Safety, Tolerability, and Efficacy—A Report from the GESICA Registry

Nul¹,

Zambrano²,

Díaz³

et al. 2005

Cardiovasc Drugs Ther

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Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA) studied whether a standardized protocol for the initiation and titration of the beta-blocker carvedilol in a multicenter, open-label program would optimize beta-blocker use in heart failure (HF) patients. The program included: (1) the carvedilol initiation and titration period, and (2) long-term follow-up at 6 and 12 months. Of 1299 patients in the registry, 504 were excluded due to current therapy; of the remaining 795 eligible patients, 293 were excluded due to contraindications. Of the included patients with follow-up data (n = 316), 93.3% tolerated carvedilol initiation and 47.7% of the patients reached the target dose of 50 mg/day for a mean dose of 39 mg/day. Rates were comparable in the elderly (n = 83), of which 53% achieved a target dose for a mean dose of 43.08 mg/day. This protocol improved therapy rates and achieved target doses quickly (average of 4 visits). Concomitant medications did not have to be adjusted and there were low withdrawal rates (10%) and hospital admissions (7.2%) for HF. Patients were able to maintain carvedilol therapy at 6 and 12 months. These results indicate that a standardized titration protocol, as used in GESICA, for the initiation and titration of beta-blockers is well tolerated and may improve beta-blocker use in carefully selected heart failure patients.

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Section: Discussionsupporting

confidence: 88%

Impact of a Standardized Titration Protocol with Carvedilol in Heart Failure: Safety, Tolerability, and Efficacy—A Report from the GESICA Registry

Nul¹,

Zambrano²,

Díaz³

et al. 2005

Cardiovasc Drugs Ther

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“…Consensus guidelines recommend that all patients with systolic heart failure and without contraindications be treated with a β‐blocker, and most can be maintained on some β‐blocker dose. It is recognized that there are certain challenges associated with the initiation of β‐blocker therapy in heart failure, and known clinical and demographic risk factors that are associated with worsening heart failure 31 , 41 should be taken into account and titration individualized on the basis of the clinical condition of the patient. In the future, genetic information may also be helpful in individualizing the titration plan.…”

Section: Discussionmentioning

confidence: 99%

β-adrenergic Receptor Polymorphisms and Responses during Titration of Metoprolol Controlled Release/extended Release in Heart Failure*

Terra

Pauly

Lee

et al. 2005

Clin Pharmacol Ther

118

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“…14 Patient response to β-blocker therapy differs and efforts to predict which patients will respond to the therapy are imprecise. 15 Clinicians who struggle with β blocker initiation and up-titration in HF are often concerned about whether a particular patient can hemodynamically tolerate the agent 16 and are also lacking real-time quantitative tools to aid this assessment. In this case example, monitoring and trending of the hemodynamic parameters provided by ICG assisted the clinicians in reaching the recommended therapeutic dose of carvedilol.…”

Section: Discussionmentioning

confidence: 99%

Case Report. Use of Noninvasive Hemodynamics to Aid Decision Making in the Initiation and Titration of Neurohormonal Agents

Summers

Parrott

Quale

et al. 2004

Congestive Heart Failure

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Angiotensin-converting enzyme inhibitors, beta adrenergic blockers, and nesiritide are pharmacologic agents for heart failure with both short- and long-term neurohormonal and hemodynamic effects. Angiotensin-converting enzyme inhibitors and beta adrenergic blockers reduce morbidity and mortality in chronic heart failure. Higher doses may result in better outcomes than lower doses, but concern about hemodynamic tolerance is a major barrier to the initiation and up-titration of these agents. Nesiritide is a newer neurohormonal agent with proven efficacy and safety for use in decompensated heart failure, but appropriate patient selection has been challenging for clinicians. Like vasodilators, nesiritide may be underutilized in heart failure treatment. Impedance cardiography is a newer, noninvasive monitoring technology that can accurately measure hemodynamic parameters. Impedance cardiography is being used with increasing frequency by clinicians to guide therapy in patients with heart failure and has been proposed in heart failure treatment algorithms. Three case reports are presented to illustrate how hemodynamic data using impedance cardiography can be utilized in the initiation and titration of neurohormonal agents.

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Predicting response to carvedilol for the treatment of heart failure: A multivariate retrospective analysis

Cited by 25 publications

References 21 publications

Impact of a Standardized Titration Protocol with Carvedilol in Heart Failure: Safety, Tolerability, and Efficacy—A Report from the GESICA Registry

Impact of a Standardized Titration Protocol with Carvedilol in Heart Failure: Safety, Tolerability, and Efficacy—A Report from the GESICA Registry

β-adrenergic Receptor Polymorphisms and Responses during Titration of Metoprolol Controlled Release/extended Release in Heart Failure*

Case Report. Use of Noninvasive Hemodynamics to Aid Decision Making in the Initiation and Titration of Neurohormonal Agents

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