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Carvedilol effective in heart failure patients with concomitant atrial fibrillation

מתוך medicontext.co.il

By Will Boggs, MD

WESTPORT, CT (Reuters Health) – Carvedilol improves cardiac function and survival in patients with congestive heart failure and concomitant atrial fibrillation, according to a report in the September issue of American Heart Journal.

"In patients with atrial fibrillation and heart failure, carvedilol appears to provide the same benefits as in the non-atrial-fibrillation population," Dr. Jose A. Joglar from the University of Texas Southwestern Medical Center at Dallas told Reuters Health.

Dr. Joglar and colleagues analyzed data from 136 participants in the US Carvedilol Heart Failure Trials Program to determine whether patients with both AF and symptomatic CHF benefited from carvedilol therapy.

Carvedilol treatment brought a significant improvement in left ventricular ejection fraction compared with placebo treatment (p = 0.001), the authors report. Global assessment ratings by physicians improved in a larger proportion of carvedilol-treated patients (71%) than placebo-treated patients (48%) (p = 0.025).

"Although beta-blockers have been shown to improve ejection fraction and survival in patients with CHF, the extension of the hemodynamic benefit to the subset of patients with CHF with AF is a novel finding," the investigators say.

"This is a retrospective analysis and as such it has limitations," Dr. Joglar said, "but the results are provocative enough to make me wonder whether aggressive reductions in heart rate with carvedilol in patients with atrial fibrillation would result in even more pronounced benefits. Further studies are needed to look into this question of what should be the target heart rate/ventricular response in these patients."

"I think that for patients with heart failure and atrial fibrillation with rapid ventricular response, the drug of choice for controlling the ventricular response should be a beta-blocker," Dr. Joglar concluded, "probably carvedilol."

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