Question Title: Carvedilol and CHF

Forum: The Heart Forum
Topic: Heart - General

Posted by CCF Cardio MD sc on August 26, 1997 at 19:02:27:

In Reply to: Carvedilol and CHF posted by Karen Kording on August 22, 1997 at 20:12:09:

: I have followed with interest all of the information about Carvedilol and its use for those with CHF. My question is: Is there any documentation of Carvedilol being used to treat CHF in a patient with an ejection fraction greater than 35% (42%) and considered to be a NY Class I.

My doctor is very interested in putting me on this medication and I believe it would be appropriate. He did ask a doctor at the University of Iowa and was told that he could not say whether it would harm me or be helpful. I understand why he said this since all the trials used patients with ejection fractions <35%.

Thanks for any information.
Karen

Thank you for your very valid question. As you have correctly outlined in you question nearly all of the studies with carvedolol in the setting of heart failure have been done in patients with Ejection fractions of 35% or less, and with NYHA Class II symptoms. I have attempted to review the medical literature over the last 8 years and have not been able to find any randomized studies were it was used for patients with EF greater than 40%. The only possible relevant study was one in which the drug was used in 24 patients with no symptoms and with EF of 40%. In this study there was a slight improvement in the EF to 48% with a decrease in Left ventricular size suggesting improvement in her condition. The problem with this study is that because of the small number of patients all the result may be due to what is called a beta error or putting it simply just due to chance. Moreover measuring EF is not a very accurate procedure and with the small number of patients it is difficult to say that there really was an improvement in cardiac function. Therefore to conclude I would like to say that your doctors in Iowa were accurate in saying that at this point in time there is no way of saying if treatment with cardvedolol in your case would be beneficial or harmful. I apologize for not being able to give you a clearer answer at this point. If you feel you have any further questions or you would like to be seen by members of our heart failure staff here at the Cleveland Clinic for an in depth evaluation please feel free to call 1-800-CCF CARE for an appointment.

Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician(s).

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