Predicting response to carvedilol for the treatment of heart failure: A multivariate retrospective analysis

Background: Carvedilol has been shown to decrease the progression of heart failure and improve left ventricular function and survival in patients with a left ventricular ejection fraction (LVEF) less than 35%, However, not al l patients respond uniformly to this therapy. We proposed to identify varia bles that could, potentially, be used to predict response to carvedilol the rapy as measured by the change in LVEF after treatment (Delta LVEF), and to identify pretreatment variables associated with hospitalization for heart failure after carvedilol therapy. Methods and Results: A retrospective analysis of 98 patients treated with o pen-label carvedilol for a mean period of 16 months was performed by using bivariate and step-wise multivariate analyses. Bivariate analysis showed a positive correlation of Delta LVEF with heart rate at baseline (P = .001). There was a negative correlation of Delta LVEF with baseline LVEF (P < .01) , diabetes mellitus (P = .04), and ischemic cardiomyopathy (P = .0002). Mul tivariate analysis showed a positive correlation of <Delta>LVEF with heart rate at baseline (P = .01) and a negative correlation with initial LVEF (P = .02) and ischemic cardiomyopathy (P = .006). Variables associated with ho spitalization after initiation of carvedilol therapy were New York Heart As sociation (NYHA) classification (P = .001), lower extremity edema (P = .001 ), presence of an S3 (P = .02), hyponatremia (P = .02). elevated blood urea nitrogen (BUN) (P = .002), atrial fibrillation (P = .001), diabetes mellit us (P = .02), and obstructive sleep apnea (P = .009). Conclusions: Heart failure patients with the lowest LVEF or the highest hea rt rate at baseline had the greatest gain in LVEF after treatment with carv edilol. Patients with ischemic cardiomyopathy derived less benefit. Patient s with clinical evidence of decompensated heart failure were at greater ris k for hospitalization after initiation of carvedilol therapy.