The Pharmaceutical Journal
Vol 270 No 7255 p882
28 June 2003

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European Society of Cardiology (www.escardio.org)
The Lancet (www.thelancet.com)

Call for heart failure prescribing change

Prescribing practice in relation to beta-blockers for treating heart failure should change, according to cardiologists at the European Society of Cardiology heart failure meeting in Strasbourg this week. Their call follows presentation of results from the longest and largest study in chronic heart failure (CHF).

Professor Philip Poole-Wilson from Imperial College, London, and Professor John Cleland, from the University of Hull, say that the non-selective beta-blocker, carvedilol (Eucardic), should be the beta-blocker of choice in CHF.

Results from COMET (carvedilol or metoprolol European trial), based on more than 14,000 patient years of follow up, show that patients treated with carvedilol gain a survival benefit of 17 per cent compared with the beta1 selective beta-blocker, metoprolol (P=0.0017). This reduction in mortality was consistent in all sub-groups. The mean doses of carvedilol and metoprolol were 42mg and 85mg, respectively.

COMET is the first head-to-head survival study comparing two beta blocking agents in CHF. Professor Poole-Wilson, who chaired the COMET steering committee, said: "The survival benefit seen in this trial is as significant as the SOLVD trial." SOLVD (studies of left ventricular dysfunction) assessed the effect of enalapril on mortality.

The trial, funded jointly by Roche and GlaxoSmithKline, was designed to compare the effects of carvedilol with those of metoprolol on the risk of death and hospital admission. Full results are due to be published in The Lancet next month.

COMET investigators said that the difference in mortality observed between the two treatment groups was due to pharmacological differences between carvedilol and metoprolol. Professor Poole-Wilson said that carvedilol's ability to block beta₂ receptors as well as beta₁ receptors probably accounted for the difference.