Journal of cardiac failure
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Randomized Controlled Trial Clinical Trial
Consistency of the beneficial effect of metoprolol succinate extended release across a wide range dose of angiotensin-converting enzyme inhibitors and digitalis.
The effects of beta-blockade with different extent of angiotensin-converting enzyme inhibitors (ACEI) and digitalization are unknown. To assess the effect of metoprolol succinate controlled release/extended release (CR/XL) combined with high versus low doses of ACEI and digitalis, we analyzed data from The Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) in which patients with heart failure and left ventricular ejection fraction < or =40% were randomized to metoprolol CR/XL versus placebo. ⋯ This analysis of MERIT-HF demonstrates consistent and similar improvement in outcome of patients receiving metoprolol CR/XL when combined with either a high or low dose of an ACEI or digitalis, or no digitalis at all. Thus regardless of ACEI and digitalis dose and whether patients are treated with digitalis or not, it is very important to add a beta-blocker to the existing heart failure therapy. beta-blockers should not be withheld until target doses of ACEI have been achieved.
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Randomized Controlled Trial Clinical Trial
Effect of Valsartan on hospitalization: results from Val-HeFT.
Although current therapies have improved heart failure (HF) outcome, hospitalizations continue at high rates. The Valsartan Heart Failure Trial (Val-HeFT) showed that valsartan reduced the risk of first worsening HF hospitalization by 27.5% versus placebo (P <.001). This article analyzes all-cause and investigator-assessed HF hospitalization in Val-HeFT overall and in subgroups defined by preexisting HF therapy. ⋯ Addition of valsartan to prescribed HF therapy demonstrated significant reductions in HF hospitalizations and was particularly beneficial in reducing recurrent HF hospitalization.
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Randomized Controlled Trial Clinical Trial
African-American Heart Failure Trial (A-HeFT): rationale, design, and methodology.
Hydralazine and isosorbide dinitrate combination (H+ISDN), angiotensin-converting enzyme inhibitors, and beta-blockers have improved outcomes in heart failure (HF). Analysis of previous trials has shown that H+ISDN appears especially beneficial in African American patients. ⋯ In addition to providing additional information on BiDil efficacy in HF, A-HeFT is the first HF trial aimed at a selected subgroup of patients and the first to use a new composite HF score as its primary efficacy endpoint.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effects of metoprolol CR/XL on mortality and hospitalizations in patients with heart failure and history of hypertension.
We describe the effect of controlled-release/extended-release (CR/XL) metoprolol succinate once daily on mortality and hospitalizations among patients with a history of hypertension complicated by chronic systolic heart failure. ⋯ A subgroup analysis of MERIT-HF shows that patients with heart failure and a history of hypertension received a similar benefit from metoprolol CR/XL treatment as all patients included in the total study.
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Randomized Controlled Trial Clinical Trial
Hemodynamic profiles of advanced heart failure: association with clinical characteristics and long-term outcomes.
Classifying patients with advanced congestive heart failure (CHF) by baseline measures of congestion and perfusion has been used to estimate hemodynamic status and to select and titrate therapy. We describe clinical characteristics of 4 hemodynamic profiles-wet/cold, wet/warm, dry/cold, and dry/warm-in patients with advanced CHF and assess relations between symptoms, physical signs, and outcomes with each profile. ⋯ The patient's history and physical examination alone may lead to inaccurate estimation of hemodynamic status and thus suboptimal management for patients with advanced CHF.