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KMID : 0338420190340051030
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The Korean Journal of Internal Medicine
2019 Volume.34 No. 5 p.1030 ~ p.1039
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The mortality benefit of carvedilol versus bisoprolol in patients with heart failure with reduced ejection fraction
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Choi Ki-Hong
Lee Ga-Yeon
Choi Jin-Oh
Jeon Eun-Seok
Lee Hae-Young
Lee Sang-Eun
Kim Jae-Joong
Chae Shung-Chull
Baek Sang-Hong
Kang Seok-Min
Choi Dong-Ju
Yoo Byung-Su
Kim Kye-Hun
Cho Myeong-Chan
Park Hyun-Young
Oh Byung-Hee
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Abstract
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Background/Aims: It is unknown whether different β-blockers (BBs) have variable effects on long-term survival of patients with heart failure with reduced ejection fraction (HFrEF). This study compares the effects of two BBs, carvedilol and bisoprolol, on survival in patients with HFrEF.
Methods: The Korean Acute Heart Failure (KorAHF) registry is a prospective multicenter cohort that includes 5,625 patients who were hospitalized for acute heart failure (AHF). We selected 3,016 patients with HFrEF and divided this study population into two groups: BB at discharge (n = 1,707) or no BB at discharge (n = 1,309). Among patients with BB at discharge, subgroups were formed based on carvedilol prescription (n = 831), or bisoprolol prescription (n = 553). Propensity score matching analysis was performed.
Results: Among patients who were prescribed a BB at discharge, 60.5% received carvedilol and 32.7% received bisoprolol. There was a significant reduction in allcause mortality in those patients with HFrEF prescribed a BB at discharge compared to those who were not (BB vs. no BB, 26.1% vs. 40.8%; hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.52 to 0.67; p < 0.001). However, there was no significant difference in the rate of all-cause mortality between those receiving different types of BB (carvedilol vs. bisoprolol, 27.5% vs. 23.5%; HR, 1.21; 95% CI, 0.99 to 1.47; p = 0.07). Similar results were observed after propensity score matching analysis (508 pairs, 26.2% vs. 23.8%; HR, 1.10; 95% CI, 0.86 to 1.40; p = 0.47).
Conclusions: In the treatment of AHF with reduced EF after hospitalization, mortality benefits of carvedilol and bisoprolol were comparable.
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KEYWORD
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Beta-blocker, Heart failure with reduced ejection fraction, Carvedilol, Bisoprolol
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