Death and hospitalization in heart failure patients receiving carvedilol vs. metoprolol tartrate.

BACKGROUND: The Carvedilol or Metoprolol European Trial (COMET) demonstrated improved survival with carvedilol vs. metoprolol tartrate in patients with heart failure. The benefits of carvedilol in typical clinical practice in the United States are unknown.

METHODS: Using data from a large United States health-insurance claims database, we conducted a retrospective study to compare the risks of death and hospitalization and the cost of inpatient care in heart failure patients receiving carvedilol vs. metoprolol tartrate. The sample consisted of all patients with a prescription for carvedilol or metoprolol tartrate between September 1997 and August 2000 who also had a prior medical encounter with a primary diagnosis of heart failure, prior prescriptions for a loop diuretic and an angiotensin-converting enzyme inhibitor, and no prior prescriptions for a beta-blocker.

RESULTS: We identified 887 carvedilol patients and an equal number that received metoprolol tartrate. Mean duration of follow-up was 11 months (maximum, 36 months). Controlling for baseline characteristics using a Cox proportional hazards model, carvedilol was independently associated with a reduced risk of all-cause mortality (hazard ratio 0.78; 95% confidence interval 0.61 to 0.99) and all-cause hospitalization (hazard ratio 0.77; 95% confidence interval 0.67 to 0.90). In a propensity-matched sample of carvedilol and metoprolol tartrate patients (n = 564 each), expected costs of inpatient care at 36 months were 10,509 US dollars lower with carvedilol (95% confidence interval 2934-18,085 US dollars).

CONCLUSIONS: Use of carvedilol rather than metoprolol tartrate may improve survival and reduce costs of care in heart failure patients in typical clinical practice in the United States.