Ninety-eight patients with acutely decompensated systolic heart failure were admitted to the Hospital Universitario de Los Andes between 2005 and 2011, in Mérida, Venezuela. Medical Treatment: Protocol 1: Furosemide 20 mg IV every 8 hours (28 patients). Protocol 2: Furosemide 20 IV every 24 hours plus cautious uptitration of carvedilol (70 patients). Heart rate decreased from 99.19±12.38 to 67.64±11.27 (bpm) (p < 0.0001) with protocol 2. Daily weight changes were similar both protocols. Mean maximum dose of carvedilol was 59.37 mg, furosemide 240 mg for protocol 1 and 80 mg for protocol 2. For the whole group of patients, survival probability was close to 60% at fifty months of follow up. There were fourteen deaths with protocol 1 and eleven with protocol 2. Survival probability was significantly higher, in patients assigned to protocol 2 versus protocol 1 (72% vs 38%, p< 0.046). Cox multiple regression analysis indicated that, medical treatment with carvedilol, was significantly and independently associated to survival, only in those patients who were in sinus rhythm. Cautious uptitration of carvedilol, in still decompensated patients with sinus rhythm, increases long term survival.
| Published in | American Journal of Internal Medicine (Volume 9, Issue 4) |
| DOI | 10.11648/j.ajim.20210904.14 |
| Page(s) | 186-193 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Furosemide, Carvedilol, Acute Decompensated Systolic Heart Failure, Heart Rate, Survival Probability
| [1] | Tsutsui M, Tsuchihashi M and Takeshita A. Mortality and Readmission of hospitalized Patients with Congestive Heart Failure and Preserved Versus Depressed Systolic Function. Am J Cardiol 2001; 88: 530–533. |
| [2] | Feinglass J, Lee PI, Mehta S, Schmitt B, Lefevre F, Gheorghiade M Systolic function, readmission rates, and survival among consecutively hospitalized patients with congestive heart failure. Am Heart J 1997; 134: 728-736. |
| [3] | Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB et al. Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Investigators. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circ 2007; 116: 1482-1487. |
| [4] | Konishi M, Maejima Y, Inagaki H, Clinical characteristics of acute decompensated heart failure with rapid onset symptoms. J Card Fail 2009; 15: 300-304. |
| [5] | Schiff GD, Fung S, Speroff T, Mcnutt RA. Decompensated heart failure: Symptoms, patterns of onset and contributing factors. Am J Med 2003; 114: 625-630. |
| [6] | Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD et al. Value of clinician assessment of hemodynamics in advanced heart failure. Circ Heart Fail 2008; 1: 170-177. |
| [7] | Nohria A, Tsang SW, Fang JC, Lewis EF, Jarcho JA, Mudge GH et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 2003; 41: 1797-1784. |
| [8] | Tuy T, Peacock WF. Fluid overload assessment and management in heart failure patients. Semin Nephrol 2012; 32: 112-120. |
| [9] | Khoury AM, Davila DF, Bellabarba G, Donis JH, Torres A, Hernandez L et al. Acute effects of digitalis and enalapril on the neurohormonal profile of chagasic patients with severe congestive heart failure. Int J Cardiol 1996; 57: 21-29. |
| [10] | Gheorghiade M, Pang PS, Ambrosy AP, Lan G, Schmidt P, Filippatos G, Konstam M et al. A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial. Heart Fail Rev 2012; 17: 485-509. |
| [11] | Felker GM, Hasselblad V, Wilson Tang WH et al, Troponin I in acute decompensated heart failure: insights from the ASCEND-HF study. European Journal of Heart Failure 2012; 14: 1257–1264. |
| [12] | Peacock WF, Costanzo MR, De Marco T, Lopatin M, Wynne J, Mills RM et al. ADHERE Scientific Advisory Committee and Investigators. Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry. Cardiology 2009; 113: 12-19. |
| [13] | Vaz Pérez A, Otawa K, Zimmermann AV, Stockburger M, MüllerWerdan U et al. The impact of impaired renal function on mortality in patients with acutely decompensated chronic heart failure. Eur J Heart Fail. 2010; 12: 122-128. |
| [14] | Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR et al. NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011; 364: 797-805. |
| [15] | Konish M, Haraguchi G, Ohigashi H et al. Progression of Hyponatremia is Associated with Increased Cardiac Mortality in Patients Hospitalized for Acute Decompensated Heart Failure. J Cardiac Fail 2012; 18: 620-625. |
| [16] | Mc Murray JJ. Clinical Practive. Systolic Heart Failure. N Eng. J Med 2010; 362: 228-38. |
| [17] | McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 802-869. |
| [18] | Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Young JB et al. OPTIMIZE-HF Investigators and Coordinators, Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZEHF program. J Am Coll Cardiol. 2008; 52: 190-199. |
| [19] | Orso F, Baldasseroni S, Fabbri G, Gonzini L, Lucci D, D'Ambrosi C et al. Italian Survey on Acute Heart Failure Investigators. Role of Beta Blockers in patients admitted for worsening heart failure in a real world: data from the Italian Survey on Acute Heart Failure. Eur J Heart Fail 2009; 11: 77–84. |
| [20] | Lobo-Vielma L, Comenares-Mendoza H, Donis JH, Sanchez F, Perez A, Dávila DF. Acutely decompensated heart failure: Effects of carvedilol on clinical status, neurohormonal activation and ventricular arrhythmias. Int J Cardiol 2010; 144: 302-303. |
| [21] | OH JK, Park SJ, Nagueh SF. Stablished and novel clinical applications of diastolic function assessment by echocardiography. Circ Cardiovasc Imaging 2011; 4: 444-455. |
| [22] | Cotter G, Felker GM, Adams KF, Milo-Cotter O, O'Connor CM. The pathophysiology of acute heart failure--is it all about fluid accumulation? Am Heart J. 2008; 155: 9-18. |
| [23] | Fallick C, Sobotka PA, Dunlap ME. Sympathetically mediated changes in capacitance: redistribution of the venous reservoir as a cause of decompensation. Circ Heart Fail. 2011; 4: 669-75. |
| [24] | Gelman S, Mushlin PS. Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology 2004; 100: 434-439. |
| [25] | Francis GS, Siegel RM, Goldsmith SR, Olivari MT, Levine TB, Cohn JN. Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Ann Intern Med. 1985, 103: 1-6. |
| [26] | Waagstein F, Hjalmarson A, Varnauskas E, Wallentin I. Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J. 1975; 37: 1022-1036. |
| [27] | Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. 1996; 334: 1349-1355. |
| [28] | Metra M, Torp-Pedersen C, Cleland JG, Di Lenarda A, Komajda M, Remme WJ et al. COMET investigators. Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET. Eur J Heart Fail. 2007; 9: 901-909. |
| [29] | Jondeau G, Neuder Y, Eicher JC, Jourdain P, Fauveau E, Galinier M et al. B-CONVINCED Investigators. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009; 30: 2186-2192. |
| [30] | Kaye DM, Lefkovits J, Jennings GL, Bergin P, Broughton A, Esler MD. Adverse consequences of high sympathetic nervous activity in the failing human heart. J Am Coll Cardiol. 1995; 26: 1257-1263. |
| [31] | Dávila DF, Núñez TJ, Odreman R, de Dávila CA. Mechanisms of neurohormonal activation in chronic congestive heart failure: pathophysiology and therapeutic implications. Int J Cardiol. 2005; 101: 343-346. |
| [32] | Davila DF, Donis JH, Bellabarba G, Torres A, Casado J, Mazzei de Davila C. Cardiac afferents and neurohormonal activation in congestive heart failure. Med Hypotheses. 2000; 54: 242-253. |
| [33] | Nikolaidis LA, Poornima I, Parikh P, Magovern M, Shen YT, Shannon RP. The effects of combined versus selective adrenergic blockade on left ventricular and systemic hemodynamics, myocardial substrate preference, and regional perfusion in conscious dogs with dilated cardiomyopathy. J Am Coll Cardiol. 2006; 47: 1871-1881. |
| [34] | Azevedo ER, Kubo T, Mak S, Al-Hesayen A, Schofield A, Allan R et al. Nonselective versus selective beta-adrenergic receptor blockade in congestive heart failure: differential effects on sympathetic activity. Circulation 2001; 104: 2194-2199. |
| [35] | Aggarwal A, Wong J, Campbell DJ. Carvedilol reduces aldosterone release in systolic heart failure. Heart Lung Circ. 2006; 15: 306-309. |
| [36] | Hawkins NM, Petrie MC, Macdonald MR, Jhund PS, Fabbri LM, Wikstrand J et al. Heart failure and chronic obstructive pulmonary disease the quandary of Beta-blockers and Beta-agonists. J Am Coll Cardiol 2011; 57: 2127-2138. |
APA Style
Francisco Jose Sánchez Rivas, Jose Hipolito Donis Hernández, Carmen Mazzei De Dávila, Maite Alexandra González, Diego Fernando Dávila. (2021). Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival. American Journal of Internal Medicine, 9(4), 186-193. https://doi.org/10.11648/j.ajim.20210904.14
ACS Style
Francisco Jose Sánchez Rivas; Jose Hipolito Donis Hernández; Carmen Mazzei De Dávila; Maite Alexandra González; Diego Fernando Dávila. Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival. Am. J. Intern. Med. 2021, 9(4), 186-193. doi: 10.11648/j.ajim.20210904.14
AMA Style
Francisco Jose Sánchez Rivas, Jose Hipolito Donis Hernández, Carmen Mazzei De Dávila, Maite Alexandra González, Diego Fernando Dávila. Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival. Am J Intern Med. 2021;9(4):186-193. doi: 10.11648/j.ajim.20210904.14
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ajim.20210904.14,
author = {Francisco Jose Sánchez Rivas and Jose Hipolito Donis Hernández and Carmen Mazzei De Dávila and Maite Alexandra González and Diego Fernando Dávila},
title = {Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival},
journal = {American Journal of Internal Medicine},
volume = {9},
number = {4},
pages = {186-193},
doi = {10.11648/j.ajim.20210904.14},
url = {https://doi.org/10.11648/j.ajim.20210904.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210904.14},
abstract = {Ninety-eight patients with acutely decompensated systolic heart failure were admitted to the Hospital Universitario de Los Andes between 2005 and 2011, in Mérida, Venezuela. Medical Treatment: Protocol 1: Furosemide 20 mg IV every 8 hours (28 patients). Protocol 2: Furosemide 20 IV every 24 hours plus cautious uptitration of carvedilol (70 patients). Heart rate decreased from 99.19±12.38 to 67.64±11.27 (bpm) (p < 0.0001) with protocol 2. Daily weight changes were similar both protocols. Mean maximum dose of carvedilol was 59.37 mg, furosemide 240 mg for protocol 1 and 80 mg for protocol 2. For the whole group of patients, survival probability was close to 60% at fifty months of follow up. There were fourteen deaths with protocol 1 and eleven with protocol 2. Survival probability was significantly higher, in patients assigned to protocol 2 versus protocol 1 (72% vs 38%, p< 0.046). Cox multiple regression analysis indicated that, medical treatment with carvedilol, was significantly and independently associated to survival, only in those patients who were in sinus rhythm. Cautious uptitration of carvedilol, in still decompensated patients with sinus rhythm, increases long term survival.},
year = {2021}
}
TY - JOUR T1 - Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival AU - Francisco Jose Sánchez Rivas AU - Jose Hipolito Donis Hernández AU - Carmen Mazzei De Dávila AU - Maite Alexandra González AU - Diego Fernando Dávila Y1 - 2021/07/09 PY - 2021 N1 - https://doi.org/10.11648/j.ajim.20210904.14 DO - 10.11648/j.ajim.20210904.14 T2 - American Journal of Internal Medicine JF - American Journal of Internal Medicine JO - American Journal of Internal Medicine SP - 186 EP - 193 PB - Science Publishing Group SN - 2330-4324 UR - https://doi.org/10.11648/j.ajim.20210904.14 AB - Ninety-eight patients with acutely decompensated systolic heart failure were admitted to the Hospital Universitario de Los Andes between 2005 and 2011, in Mérida, Venezuela. Medical Treatment: Protocol 1: Furosemide 20 mg IV every 8 hours (28 patients). Protocol 2: Furosemide 20 IV every 24 hours plus cautious uptitration of carvedilol (70 patients). Heart rate decreased from 99.19±12.38 to 67.64±11.27 (bpm) (p < 0.0001) with protocol 2. Daily weight changes were similar both protocols. Mean maximum dose of carvedilol was 59.37 mg, furosemide 240 mg for protocol 1 and 80 mg for protocol 2. For the whole group of patients, survival probability was close to 60% at fifty months of follow up. There were fourteen deaths with protocol 1 and eleven with protocol 2. Survival probability was significantly higher, in patients assigned to protocol 2 versus protocol 1 (72% vs 38%, p< 0.046). Cox multiple regression analysis indicated that, medical treatment with carvedilol, was significantly and independently associated to survival, only in those patients who were in sinus rhythm. Cautious uptitration of carvedilol, in still decompensated patients with sinus rhythm, increases long term survival. VL - 9 IS - 4 ER -
Email: