Congestive Heart FailureComparative effects of carvedilol and metoprolol on left ventricular ejection fraction in heart failure: Results of a meta-analysis☆
Section snippets
Methods
We carried out an extensive search of all controlled trials with metoprolol or carvedilol in heart failure by performing a MEDLINE search with the following key words: β-blockers, congestive heart failure, and human. The search was carried out independently by 2 of the authors (G. V. A. and M. P.). The trials obtained by this search were supplemented by additional information obtained from the reference lists of published articles.
Results
Nineteen clinical trials21, 22, 23, 24, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47 with carvedilol or metoprolol (or both) in heart failure met the criteria for inclusion in the current meta-analysis (Table I).
Discussion
The data and analyses summarized in the current article demonstrate that carvedilol produces greater increases in left ventricular ejection fraction than metoprolol does when the 2 drugs are used for the treatment of chronic heart failure. The difference in the effects of the 2 β-blockers was apparent both in placebo-controlled trials (which compared each drug with placebo) and in active-controlled trials (which directly compared the 2 drugs with each other); more than 2000 patients were
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Reprint requests: James E. Udelson, MD, Division of Cardiology, Tufts University School of Medicine, Boston, MA 02111.