Source: Depress Anxiety  |  Posted 10 years ago

By Ed Susman

ATLANTA, GA -- March 19, 2002 -- Patients with heart failure could benefit more if doctors prescribed carvedilol prior to adding digitalis to their medication regimen.

In a poster presentation at the 51st Annual Scientific Session of the American College of Cardiology (ACC), Alan Miller, MD, professor of medicine at the University of Florida, Jacksonville, analyzed results of the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS), specifically looking at patients on digitalis and those not taking the drug.

"Most trials demonstrating the efficacy of beta-blockers in chronic heart failure enrolled patients receiving digitalis," Dr. Miller said. "Thus, little is known about the efficacy and safety of beta-blockers in patients who are not digitalized. Like beta-blockers, digitalis may attenuate the effects of the sympathetic nervous system, but unlike beta-blockers, digitalis exerts positive inotropic effects that may be valuable in beta-blocked patients."

The COPERNICUS study enrolled 2,289 patients, of whom 1,513 were taking digitalis and 776 were not on the drug. In comparing the two groups, Dr. Miller and colleagues found that 19.6 percent of patients taking digitalis and placebo died while 12.8 percent of those on digitalis and carvedilol died, indicating a 29 percent relative risk reduction with carvedilol.

Approximately 16.1 percent of patients not on digitalis and receiving placebo died compared to 8.0 percent of those not receiving digitalis but receiving carvedilol, indicating a 52 percent relative risk reduction, Dr. Miller said.

There were similar reductions in the end point of death or heart failure hospitalization with the risk of experiencing that end point decreasing by 29 percent if the patient was on digitalis and decreasing by 36 percent if the patient was not on digitalis.

"The effects of carvedilol on all-cause mortality and on death or heart failure hospitalization in patients not receiving digitalis were at least as large as in those receiving digitalis," Dr. Miller said. "These results indicate that digitalis is not required for the efficacy or safety of carvedilol in severe chronic heart failure.

"I think this analysis shows that doctors might be better off prescribing carvedilol to heart failure patients before they give them digitalis," Dr. Miller said. He said that digitalis might be reserved for use in treating acute symptoms of heart failure.

The COPERNICUS study was sponsored by Roche Pharmaceuticals.