Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival

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.