Forums » Open clinical » Cardiology » What is the action of carvedilol in heart faliure?
|
Re: What is the action of carvedilol in heart faliure?
posted at 29/6/2011 6:42 AM BST
on bmj.com
|
Posts: 3
First: 7/1/2011 Last: 29/6/2011 |
One of the most important factors which necessitates the prescription of beta blockers to the patients with heart failure is the overactivation of sympathetic system and the consequences of this acivation. Selection of carvidolol and other drugs among large group of beta blockers is related to the distinct properties of these drugs which include cardiac stabilizing effect, pre and afterload reducing effect, cardioselective effect (in some drugs) and others. |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 29/6/2011 7:52 AM BST
on bmj.com
|
Posts: 220
First: 10/12/2010 Last: 1/6/2012 |
Welcome to the discussion: Qasim! Results apply to all beta blockers, until further notice
Poulter added to heartwire that "some cardiologists will say that if we hadn't used atenolol the results would have been different: 'If you'd used my favorite "olol," ' for example, and I say, 'Prove it!' "
He believes that beta blockers "are not all the same, they do have different effects on all sorts of things," but "there is no evidence of heterogeneity in terms of cardiovascular outcomes," he maintains.
"Until further notice, beta blockers should not come up the pecking order on the basis of pulse rate." No progresst there!!!! |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 29/6/2011 8:51 AM BST
on bmj.com
|
Posts: 492
First: 12/7/2010 Last: 7/5/2013 |
Hi all, Here is the NNT for nevibolol using the data from the SENIORS trial – NNT to reduce the primary outcome (All cause mortality or cardiovascular hospitalization) is 23.8. It’s not clear whether the primary outcome was decided a priori but neither all cause mortality nor CV hospitalizations come out statistically significant in itself. The NNH for the adverse effects of nevibolol can also be calculated but their significance levels are not given, I would have to calculate them at first before getting on with NNH. Lots of work! Regarding the difference in NNT between carvedilol and bisoprolol, NNT does depend on the baseline risk. I think it may be possible to adjust for the baseline risk to make them comparable. |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 29/6/2011 3:06 PM BST
on bmj.com
|
Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
In Response to Re: What is the action of carvedilol in heart faliure?: Welcome to the discussion: Qasim! You are right. No problem there. Hi Sadian! I have gone through ASCOT study. Objections ar same and reply is same as in 2004 & 2006. I Qoute " Results apply to all beta blockers, until further notice Poulter added to heart wire that "some cardiologists will say that if we hadn't used atenolol the results would have been different: 'If you'd used my favorite "olol," ' for example, and I say, 'Prove it!' " He believes that beta blockers "are not all the same, they do have different effects on all sorts of things," but "there is no evidence of heterogeneity in terms of cardiovascular outcomes," he maintains. "Until further notice, beta blockers should not come up the pecking order on the basis of pulse rate." What have we been discussing for last so many days! Man ! There is no heterogenicity amongst BBs as for as cardiovascular outcomes are concerned. No progresst there!!!! Posted by ranasaleem52 Hello Fellows: Just regarding uncomplicated essential hypertension ("pure hypertension") there is indeed good evidence against using beta-blockers. I would add to the ASCOT and CAFE trials, also the LIFE sutdy that showed on a head to head basis a clear cardiovascular loss of Atenolol compared to Losartan in diabetics and non-diabetics. Also in the ARIC (Atherosclerosis Risk in Communities Study) the utilization of beta-blockers was noted as one of the risk factors for new onset diabetes: HYPERTENSION AND ANTIHYPERTENSIVE THERAPY AS RISK FACTORS FOR TYPE 2 DIABETES MELLITUS All best, Joey |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 29/6/2011 8:13 PM BST
on bmj.com
|
|
Posts: 492
First: 12/7/2010 Last: 7/5/2013 |
Thanks ranasaleem. Here are the adverse effects of nebivolol with their significance level from the SENIORS trial. Since I have done multiple significance tests, I have used Bonferroni correction to correct for alpha and the hence the resultant p value should be less than 0.003 to be significant.
Only bradycardia and lower limb oedema is statistically significant. NNH for bradycardia is 11.76 and that for lower limb oedema is 34.48. |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 30/6/2011 1:38 PM BST
on bmj.com
|
Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
Dear All, I agree with Joey R that beta -blockers are out for pure hypertension and again I'm impressed by Deb-D's stats! I think the SENIORS trial is not as good as COPERNICUS or CIBIS 2 as in these two studues mortality was reduced significantly. I guess we could adjust statistically for baseline risk but then I worry about whether we are overmanipulating the data and that what we actually need is an adequately powered study comparing the two drugs. Best, sadian |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 30/6/2011 3:27 PM BST
on bmj.com
|
|
Posts: 220
First: 10/12/2010 Last: 1/6/2012 |
I swear to God, If I understand single world based upon statistics. Probably no body can teach me any more at this stage. |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 30/6/2011 7:29 PM BST
on bmj.com
|
|
Posts: 492
First: 12/7/2010 Last: 7/5/2013 |
Hi all, After a bit more number crunching – here are the comparisons between the carvedilol, bisoprolol and nebivolol on reducing the mortality or hospital admission taking the data from COPERNICUS, CIBIS II and SENIORS trial. The drugs are compared adjusting the different baseline risk from the control event rate of the three trials.
· RRR – relative risk reduction, BR – baseline risk, ARR – absolute risk reduction, NNT – number needed to treat, duration 21 months for carvedilol and nebivolol and 2 years for bisoprolol. 
Carvedilol appears to be most effective, followed by bisoprolol and nebivolol. Note – The calculations are based on the assumption that the relative risk reduction remains same irrespective of the baseline risk. While this assumption is true for carvedilol and bisoprolol, I couldn’t find the supporting data for nebivolol. Also the COPERNICUS and SENIORS trials were followed up for 21 months while CIBIS II trial was followed up for 2 years though I do not think that there will be a significant difference in this additional 3 months. Hope this helps! |
|
|
Re: What is the action of carvedilol in heart faliure?
posted at 30/6/2011 9:40 PM BST
on bmj.com
|
|
Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
In Response to Re: What is the action of carvedilol in heart faliure?: Hi all, After a bit more number crunching – here are the comparisons between the carvedilol, bisoprolol and nebivolol on reducing the mortality or hospital admission taking the data from COPERNICUS , CIBIS II and SENIORS trial. The drugs are compared adjusting the different baseline risk from the control event rate of the three trials. Baseline risk from COPERNICUS trial RRR BR ARR NNT Carvedilol 0.1785 0.4475 0.07987875 12.51897407 Bisoprolol 0.1576 0.4475 0.070526 14.17916797 Nebivolol 0.1197 0.4475 0.05356575 18.66864554 Baseline risk from CIBIS II trial RRR BR ARR NNT Carvedilol 0.1785 0.3489 0.06227865 16.056867 Bisoprolol 0.1576 0.3489 0.05498664 18.18623578 Nebivolol 0.1197 0.3489 0.04176333 23.94445079 Baseline risk from SENIORS trial RRR BR ARR NNT Carvedilol 0.1785 0.3534 0.0630819 15.85240774 Bisoprolol 0.1576 0.3534 0.05569584 17.95466232 Nebivolol 0.1197 0.3534 0.04230198 23.63955541 · RRR – relative risk reduction, BR – baseline risk, ARR – absolute risk reduction, NNT – number needed to treat, duration 21 months for carvedilol and nebivolol and 2 years for bisoprolol. Carvedilol appears to be most effective, followed by bisoprolol and nebivolol. Note – The calculations are based on the assumption that the relative risk reduction remains same irrespective of the baseline risk. While this assumption is true for carvedilol and bisoprolol, I couldn’t find the supporting data for nebivolol. Also the COPERNICUS and SENIORS trials were followed up for 21 months while CIBIS II trial was followed up for 2 years though I do not think that there will be a significant difference in this additional 3 months. Hope this helps! Posted by Deb_D Dear Deb_D: It is not showing up entirely the NNTs in the table, I think maybe because of too many decimals in the ARRs. Thank you for your attention, Joey Rio |
Forums » Open clinical » Cardiology » What is the action of carvedilol in heart faliure?
