US Carvedilol Heart Failure Trials Program

Heart failure is a syndrome in which cardiac dysfunctionis associated with reduced exercise tolerance, ventricu-lar arrhythmias, and shortened life expectancy.1 There are almost 5 million persons in the US with heart failure; ap-proximately 400 000 new cases are diagnosed annually.2 In 1994, there were 870 000 hospital admissions for heart fail-ure in the US2; it is the leading cause of hospitalization among persons ≥65 years old.3 The total direct cost of med-ical care for patients with heart failure has been estimated to exceed $10 billion annually in the US4-11; costs of hospital-ization have been reported to exceed $7.5 billion per year.12 Traditionally, patients with heart failure have been treat-ed with digoxin, diuretics, and angiotensin-converting en-zyme (ACE) inhibitors. Most patients with heart failure, however, continue to experience disabling symptoms, fre-quent hospitalization, and a high rate of mortality despite the use of these agents; interest in new therapies has there-fore remained keen.13,14 Carvedilol is a nonselective β-receptor antagonist that also blocks α1-receptors and has antioxidant and antiprolif-erative properties.15-18 A large, multicenter, stratified, clinical trials program was recently undertaken to establish its effica-cy and safety in patients with heart failure (US Carvedilol Heart Failure Trials Program).19 In this program, which fol-lowed patients an average of 6.5 months, carvedilol was found to reduce the incidence of mortality by 65%. Car