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CLINICAL STUDY: HEART FAILURE

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

Michael B. Fowler, MB, FRCP^*, Montserrat Vera-Llonch, MD, MPH, Gerry Oster, PhD, Michael R. Bristow, MD, PhD, FACC, Jay N. Cohn, MD, FACC^||, Wilson S. Colucci, MD, FACC^¶, Edward M. Gilbert, MD, FACC^#, Mary Ann Lukas, MD, FACC^**, Michael J. Lacey, MS^**, Randel Richner, RN^**, Sarah T. Young, PhD^**, Milton Packer, MD, FACC for the U.S. Carvedilol Heart Failure Study Group

^* Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California, USA
Policy Analysis Inc., Brookline, Massachusetts, USA
Columbia Presbyterian Medical Center, New York, New York, USA
University of Colorado Health Sciences Center, Denver, Colorado, USA
^|| University of Minnesota Medical School, Minneapolis, Minnesota, USA
^¶ Boston University School of Medicine, Boston, Massachusetts, USA
^# University of Utah School of Medicine, Salt Lake City, Utah, USA
^** SmithKline Beecham Pharmaceuticals, King of Prussia, Pennsylvania, USA

Manuscript received November 12, 1999; revised manuscript received November 3, 2000, accepted January 12, 2001.

Reprint requests and correspondence: Dr. Michael B. Fowler, Falk C.V.R.C., Room 295, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305-5246
Mfowler{at}Stanford.edu

BACKGROUND

Carvedilol reduces disease progression in heart failure, but to our knowledge, its effects on hospitalizations and costs have not been evaluated.

OBJECTIVES

We examined the effects on hospitalization frequency and costs in 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 heart failure, which treated patients with placebo or carvedilol for up to 15 months (median, 6.5 months).

METHODS

Detailed resource utilization data were collected for all hospitalizations occurring between randomization and the end of follow-up. In-patient care costs were estimated based on observed levels of resource use.

RESULTS

Compared with placebo, carvedilol reduced the risk of hospitalization for any reason by 29% (p = 0.009), cardiovascular hospitalizations by 28% (p = 0.034) and heart failure hospitalizations by 38% (p = 0.041). Carvedilol also decreased the mean number of hospitalizations per patient (for cardiovascular reasons 30% [p = 0.02], for heart failure 53% [p = 0.03]). Among hospitalized patients, carvedilol reduced severity of illness during hospital admission, as reflected by shorter length of stay and less frequent use of intensive care. For heart failure hospital admissions, carvedilol decreased 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 with 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 reduces hospitalization risk as well as severity of illness and resource utilization during admission in patients with chronic heart failure.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CABG = coronary artery bypass grafting   CI = confidence interval   ICU/CCU = intensive care unit/coronary care unit   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   PTCA = percutaneous transluminal coronary angioplasty

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