Metoprolol controlled release/extended release in patients with severe heart failure: analysis of the experience in the MERIT-HF study.

Abstract

OBJECTIVES:

This study analyzed the effect of the beta(1)-selective beta-blocker metoprolol succinate controlled release/extended release (CR/XL) once daily on mortality, hospitalizations and tolerability in patients with severe heart failure.

BACKGROUND:

There continues to be resistance to the incorporation of beta-blockers into clinical care, largely due to concerns about their benefit in patients with more severe heart failure.

METHOD:

SA subgroup of patients from Metoprolol CR/XL Randomized Intervention Trial in chronic Heart Failure (MERIT-HF) in New York Heart Association (NYHA) functional class III/IV with left ventricular ejection fraction < 0.25 were identified (n = 795). The analysis was by intention-to-treat.

RESULTS:

The mean ejection fraction at baseline was 0.19, and the yearly placebo mortality during follow-up was 19.1%. Treatment with metoprolol CR/XL compared to placebo resulted in significant reductions in all predefined mortality end points including: total mortality, 45 versus 72 deaths (risk reduction 39%; 95% confidence interval 11% to 58%; p = 0.0086); sudden death, 22 vs. 39 deaths (45% [7% to 67%]; p = 0.024); and death due to worsening heart failure, 13 vs. 28 deaths (55% [13% to 77%]; p = 0.015). Metoprolol CR/XL also reduced the number of hospitalizations for worsening heart failure by 45% compared with placebo (p < 0.0001). The NYHA functional class improved in the metoprolol CR/XL group compared with placebo (p = 0.0031). Metoprolol CR/XL was well tolerated, with 31% fewer patients withdrawn from study medicine (all causes) compared with placebo (p = 0.027).

CONCLUSIONS:

This subgroup analysis of the MERIT-HF study shows that patients with severe heart failure receive a similar mortality benefit and a similar reduction in hospitalizations for worsening heart failure with metoprolol CR/XL treatment as those patients included in the total study.

• Authors: S Goldstein, B Fagerberg, Hjalmarson A, J Kjekshus, F Waagstein, H Wedel, J Wikstrand, MERIT-HF Study Group
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 38 Issue 4 Pg. 932-8 (Oct 2001) ISSN: 0735-1097 [Print] United States
• PMID: 11583861 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Delayed-Action Preparations
• Metoprolol

Topics

• Adrenergic beta-Antagonists (administration & dosage)
• Adult
• Aged
• Aged, 80 and over
• Delayed-Action Preparations
• Female
• Heart Failure (drug therapy, mortality)
• Hospitalization
• Humans
• Male
• Metoprolol (administration & dosage, analogs & derivatives)
• Middle Aged
• Multicenter Studies as Topic
• Randomized Controlled Trials as Topic