Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease

Background In patients with heart failure, P-blocker therapy improves left-ventricular function after 3-6 months of treatment, but effects of such treatment on symptoms and exercise performance are inconsistent, and the longer-term effects on death and other serious clinical events remain uncertain. We have investigated these issues in a doubleblind, placebo-controlled, randomised trial of the P-adrenergic blocker carvedilol (which also has a,-blocking properties). Methods 415 patients with chronic stable heart failure were randomly assigned treatment with carvedilol (207) or matching placebo (208). At baseline, 6 months, and 12 months, we measured left-ventricular ejection fraction, leftventricular dimensions, treadmill exercise duration, 6 min walk distance, New York Heart Association (NYHA) class, and specific activity scale (SAS) score. Double-blind followup continued for an average of 19 months, during which all deaths, hospital admissions, and episodes of worsening heart failure were documented. Findings After 12 months, left-ventricular ejection fraction had increased by 5.3% (2p