Efficacy Of Carvedilol Versus Second-generation Beta-blockers In The Treatment Of Heart Failure:A Meta-analysis

Part Ⅰ Meta-Analysis: Efficacy of carvedilol versus second-generation beta-blockers in the treatment of heart failure:a meta-analysisObjective: To conduct a meta-analysis to evaluate the efficacy of carvedilol versus second-generation beta-blockers in the treatment of heart failure(HF).Methods: Literature search was conducted using databases including PubMed,Cochrane Library,Embase,Web of Science,CNKI,VIP,CBM,WanFang Data.Randomized controlled trials(RCTs)on the use of carvedilol and second-generation beta-blockers treatment HF prior,to june 9,2018,were retrieved.Data were analyzed using RevMan 5.3,STATA 14.0 for the literature included in the study by two investigators who independently screened the literature according to inclusion and exclusion criteria,extracted the data,and assessed the risk of bias in the included studies.Results: Total of 21 studies were included for meta-analysis.The meta-analysis results demonstrated that carvedilol are more effective in improving HF symptoms [OR=2.03,95%CI(1.47,2.82),P<0.0001],and it significantly decreased systolic blood pressure(SBP)[MD=-4.51,95%CI(-6.92,-2.09),P=0.0003],Left ventricular end systolic diameter(LVESD)[MD=-2.72,95%CI(-4.57,-0.87),P=0.004],and improved left ventricular ejection fraction(LVEF)[MD=1.84,95%CI(0.34,3.33),P=0.02]than second generation beta-blockers.However,the effect in mortality secondary to HF [OR=0.62,95%CI(0.32,1.20),P=0.15],heart rate(HR)[MD=-2.57,95%CI(-6.67,1.52),P=0.22],left ventricular end diastolic diameter(LVEDD)[MD=-1.60,95%CI(-3.40,0.20),P=0.08] is equivalent.Only one study showed that carvedilol(OR=0.78,95%CI:(0.68,0.91),P=0.001)was superior to metoprolol in all-cause mortality.Subgroup analysis in the second-generation beta-blockers type used showed carvedilol significantly reduced readmission rate to HF[OR=0.37,95%CI(0.15,0.94),P=0.04],and significantly decreased diastolic blood pressure(DBP)[MD=-4.83,95%CI(-6.80,-2.87),P<0.00001] than metoprolol.Conclusion: Carvedilol was more effective than second-generation betablockers in the treatment of HF as it improve both primary endpoints,which include all-cause mortality,readmission rate to HF,and secondary endpoints,which include decreased SBP,DBP,LVESD and improved LVEF.Due to the low quality of reported literatures,higher quality RCTs are required to verify the above conclusion.Part Ⅱ Clinical Study: Use of β-blockers during hospitalization in patients with chronic heart failure:a retrospective studyObjective: To make a detailed survey of the status for β-blockers using on chronic heart failure(CHF)during hospitalizationin the Department of Cardiology,Affiliated Hospital of North Sichuan Medical College.Methods: A retrospective investigation was conducted on the use of β-blockers in patients with chronic heart failure in 2017 by using the database of inpatients in the Affiliated Hospital of North Sichuan Medical College.Results: A total of 486 patients with CHF were hospitalized in 2017 in the Department of Cardiology,Affiliated Hospital of North Sichuan Medical College,mainly due to ischemic heart disease.Among them,309 patients used β-blockers,accounting for 63.58% of patients with total CHF.They all used second-generation β-blockers,including metoprolol and bisoprolol,with an average dose of 31.65 mg/d and 3.33 mg/d.Metoprolol is most commonly used,with a total of 247 patients,accounting for 79.94% of the total.In the group analysis based on the use of β-blockers,there was a significant statistical difference in gender,age,and New York Heart Association(NYHA)functional class(P<0.05),while there was no statistical difference between the two groups in terms of ejection fraction and heart rate(P>0.05).In the analysis of heart rate,blood pressure changes and controlling rate of heart rate before and after the use of β-blockers in CHF,β-blockers can reduce heart rate,systolic blood pressure and diastolic blood pressure in patients with CHF,there was a significant statistical difference between them(P<0.001),but its controlling rate of heart rate was only 2.91%.Conclusion: 1.The main cause of CHF in our hospital in 2017 is ischemic heart disease.2.CHF patients in our hospital used a second-generation β-blockers,including metoprolol and bisoprolol,with an average dose of 31.65 mg/d and 3.33 mg/d,of which metoprolol was most commonly used.3.In the group analysis of whether or not to use β-blockers,suggesting that gender,age,and NYHA functional class may be factors influencing the use of β-blockers in CHF patients of our hospital in 2017.4.In our hospital,heart rate,blood pressure of patients with CHF is lower after using β-blockers,however controlling rate of heart rate was extremely low at discharge in 2017.