INITIATION OF CARVEDILOL FOR CARDIAC FAILURE: A TEACHING HOSPITAL EXPERIENCE IN AMBULATORY PATIENTS
S. Nicholls, P. Sanders, J. Selva-Nayagam, S. Shakib, A. Matthews, J. Faunt, F. Bochner, A. Tonkin, N. Buckley, R.A.S. Yeend, L.J. Mahar.
Royal Adelaide Hospital, Adelaide, South Australia.
Introduction: Beta blockers have now an established role in the management of systolic cardiac failure (CF). Carvedilol has been shown to have a mortality benefit in those with NYHA class II to III CF when used in addition to conventional therapy. We review our initial experience with carvedilol.
Methods: A retrospective case-record review of all patients with CF in the 6 month period after the introduction of carvedilol, at the Royal Adelaide Hospital Cardiac Clinic was performed.
Results: 300 patients with documented impairment of left ventricular systolic function were identified. 219 (73%) were male and the mean age was 66 years (21-90). 110 (37%) were in NYHA class II or III. 48 (44%) of these had a documented contraindication to therapy. In a further 23 (21%) the use of carvedilol was considered and deferred without contraindications. In 10 (9%) no contraindication could be identified for withholding therapy. The remaining 29 (26%) in this group and a further 6 patients in NYHA class 1 or 4 received carvedilol. Carvedilol prescription was significantly associated with younger age group and increased body weight (P<0.05). A trend for prescription based on worsening degree of LV dysfunction and size was observed. Of those on carvedilol, only 12 (34%) achieved doses of 50mg per day or greater. A further 9 (26%) were still in the process of having their dosage increased. 11 (31%) were unable to achieve the target dose, 4 needing to cease treatment due to adverse effects.
Conclusion: Carvedilol use is contraindicated in about half the patients meeting criteria for therapy and underutilised in the remainder. Furthermore, a number of these patients were intolerant to therapy and/or to the recommended dose escalation.
