Influence of carvedilol on hospitalizations in heart failure: Incidence, resource utilization and costs

BACKGROUND Carvedilol reduces disease progression in heart failure, hut to our knowledge, its affects on hospitalizations and costs have not been eval uated. OBJECTIVES We examined the effects on hospitalization frequency and costs i n the U.S, Carvedilol Heart Failure Trials Program. This program consisted. of four concurrent, multicenter, double-blind, placebo-controlled studies Involving 1,094 patients with New York Heart Association class II to IV hea rt failure, which treated patients with placebo or carvedilol for up to 15 months (median, 6.5 months) METHODS Detailed resource utilization data were collected far all hospitali zations occurring between randomization and the end of follow-up. In-patien t care costs were estimated based on observed levels of resource use. RESULTS Compared with placebo, carvedilol reduced the risk of hospitalizati on for any reason by 29% (p = 0.009), cardiovascular hospitalizations by 28 % (p = 0.034) and heart failure hospitalizations by 38% (p = 0.041). Carved ilol also decreased the mean number of hospitalizations per patient (for ca rdiovascular reasons 30% [p = 0.02], for heart failure 53%, [p = 0.03]), Am ong hospitalized patients, carvedilol reduced severity of illness during ho spital admission, as reflected by shorter length of stay and less frequent use of intensive care. For heart failure hospital admissions, carvedilol de creased mean length of stay by 37% (p = 0.03) and mean number of intensive care unit/coronary care unit days by 83% (p = 0.001), with similar effects on cardiovascular admissions, As a result, estimated inpatient care costs w ith carvedilol were 57% lower for cardiovascular admissions (p = 0.016) and 81%, lower for heart failure admissions (p = 0.022). CONCLUSIONS Carvedilol added to angiotensin-converting enzyme inhibition re duces hospitalization risk as well as severity of illness and resource util ization during admission in patients with chronic heart failure. (J Am Coil Cardiol 2001;37:1692-9) (C) 2001 by the American College of Cardiology.