The Efficacy Of Carvedilol In Chronic Congestive Heart Failure Treatment In The Elderly

Objective To evaluate the efficacy of carvedilol in chronic heart failure (CHF) treatment in the elderly. Methods From August 2001 to November 2002, a total of 45old patients (>65y) were enrolled whose LV ejection fraction (LVEF) bellowing 45% underwent standard therapy of CHF. 23 were assigned to carvedilol group and 22 to control group; Carvedilol were titrated from low dose to the target dose or maximal tolerance dose in addition to standard therapy in carvedilol group; Standard therapy were merely given in control group. All patients were examined with echocardiography, 6-minute walk test, liver function tests, renal function test, serum glucose test and full blood count etc. three times within six months to assess left ventricular (LV) function, exercise capacity and the effect on the others systems. Results Compared with the beginning of the study, FS, LVEF significantly increased in both groups by (22.31±5.08)%, (39.12±5.24) % to (29.10±6.23 )%, (49.99±9.48) %respectively in carvedilol group and (23.06±7.13) %> (39.79±6.70)% to (24.12±7.22)%, (41.76±6.70)% respectively in placebo group (p<0.001) at the end of the study, and there were significant differences between both groups(p=0.002); 6-min walk test showed that distance walked significantly increased in both groups by (351.36±61.29)mto(401.94±65.82)in carvedilol group, and (342.06 ±54.84) mto (358.80±58.07) m (p<0.001) , there were significant differences between both groups. No one could tolerance with carvedilol target dose (25mg,bid) in the study; 12.5 mg/d were tolerated with 12 patients (52.2%), and 25 mg/d were tolerance with 8 patients (34.8%). There were no significant differences of adverse reaction between the two groups. No significant changes of liver, renal function, blood routine test, electrolyte and blood sugar were found in both groups. The side effect of dizziness, tiredness, lower blood pressure and bradycardia were relatively more often in carvedilol group. There were 2 patients in both groups respectively whose symptoms of heart failure were aggravated. Conclusion Even the maximal tolerance dose was significantly smaller than the target dose in elderly, carvedilol could significantly increase FS, LVEF and exercise capacity of old patients with moderate or severe CHF and carvedilol was safe for the elderly.