This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.11.069v1 47/8/1603    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Cleland, J. G.F. Search for Related Content PubMed PubMed Citation Articles by Cleland, J. G.F.

CLINICAL RESEARCH: HEART FAILURE

A Comparison of the Effects of Carvedilol and Metoprolol on Well-Being, Morbidity, and Mortality (the "Patient Journey") in Patients With Heart Failure

A Report From the Carvedilol Or Metoprolol European Trial (COMET)

John G.F. Cleland, MD, FRCP, FESC, FACC^_*,_*, Andrew Charlesworth, PhD, Jacobus Lubsen, MD, PhD, Karl Swedberg, MD, PhD, Willem J. Remme, MD, PhD, FACC, FESC^||, Leif Erhardt, MD, FESC^¶, Andrea Di Lenarda, MD, FESC^#, Michel Komajda, MD^_**, Marco Metra, MD, Christian Torp-Pedersen, MD, Philip A. Poole-Wilson, MD, FRCP, FESC, FMedSci for the COMET Investigators

^_* University of Hull, Kingston-upon-Hull, United Kingdom
Nottingham Clinical Research Group, Nottingham, United Kingdom
SOCAR Research SR, Nyon, Switzerland; Erasmus Medical Centre, Rotterdam, the Netherlands
Sahlgrenska University Hospital/Östra, Göteborg, Sweden
^|| Sticares Cardiovascular Research Foundation, Rhoon, the Netherlands
^¶ Malmo University Hospital, Malmo, Sweden
^# Ospedale di Cattinara, Trieste, Italy
^_** La Pitié-Salpétrière Hospital, Paris, France
Università di Brescia, Brescia, Italy
Bispebjerg University Hospital, Copenhagen, Denmark
National Heart and Lung Institute, Imperial College, London, United Kingdom

Manuscript received June 28, 2005; revised manuscript received October 17, 2005, accepted November 16, 2005.

^_* Reprint requests and correspondence: Dr. John G. F. Cleland, Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom (Email: j.g.cleland{at}hull.ac.uk).

OBJECTIVES: This study was designed to investigate the loss of well-being, in terms of life-years, overall and in patients randomized to metoprolol versus carvedilol in the Carvedilol Or Metoprolol European Trial (COMET).

BACKGROUND: The ultimate objectives of treating patients with heart failure are to relieve suffering and prolong life. Although the effect of treatment on mortality is usually described in trials, the effects on patient well-being throughout the trials’ courses are rarely reported.

METHODS: A total of 3,029 patients randomized in the COMET study were included in the analysis. "Patient journey" was calculated by adjusting days alive and out of hospital over four years using a five-point score completed by the patient every four months, adjusted according to the need for intensification of diuretic therapy. Scores ranged from 0% (dead or hospitalized) to 100% (feeling very well).

RESULTS: Over 48 months, 17% of all days were lost through death, 1% through hospitalization, 23% through impaired well-being, and 2% through the need for intensified therapy. Compared with metoprolol, carvedilol was associated with fewer days lost to death, with no increase in days lost due to impaired well-being or days in hospital. The "patient journey" score improved from a mean of 54.8% (SD 26.0) to 57.4% (SD 26.3%) (p < 0.0068).

CONCLUSIONS: Despite treatment with beta-blockers, heart failure remains associated with a marked reduction in well-being and survival. Loss of quality-adjusted life-years through death and poor well-being seemed of similar magnitude over four years, and both were much larger than the loss that could be attributed to hospitalization.

Abbreviations and Acronyms   COMET = Carvedilol Or Metoprolol European Trial   HF = heart failure   NYHA = New York Heart Association

This article has been cited by other articles:

				C. Linde, W. T. Abraham, M. R. Gold, M. St. John Sutton, S. Ghio, C. Daubert, and REVERSE (REsynchronization reVErses Remodeling in Randomized Trial of Cardiac Resynchronization in Mildly Symptomatic Heart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure Symptoms J. Am. Coll. Cardiol., December 2, 2008; 52(23): 1834 - 1843. [Abstract] [Full Text] [PDF]

				L. W. Stevenson, A. S. Hellkamp, C. V. Leier, G. Sopko, T. Koelling, J. W. Warnica, W. T. Abraham, E. K. Kasper, J. G. Rogers, R. M. Califf, et al. Changing Preferences for Survival After Hospitalization With Advanced Heart Failure J. Am. Coll. Cardiol., November 18, 2008; 52(21): 1702 - 1708. [Abstract] [Full Text] [PDF]

				N. M. Albert Switching to Once-Daily Evidence-Based -Blockers in Patients With Systolic Heart Failure or Left Ventricular Dysfunction After Myocardial Infarction Crit. Care Nurse, December 1, 2007; 27(6): 62 - 72. [Full Text] [PDF]

				M. Pocar, A. Moneta, A. Grossi, and F. Donatelli Coronary Artery Bypass for Heart Failure in Ischemic Cardiomyopathy: 17-Year Follow-Up Ann. Thorac. Surg., February 1, 2007; 83(2): 468 - 474. [Abstract] [Full Text] [PDF]

				L. W. Stevenson and E. Lewis Mapping the Journey J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1612 - 1614. [Full Text] [PDF]