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Metoprolol controlled release/extended release in patients with severe heart failure

Analysis of the experience in the MERIT-HF study

Sidney Goldstein, MD^*, Björn Fagerberg, MD, PhD, Åke Hjalmarson, MD, PhD, John Kjekshus, MD, PhD, Finn Waagstein, MD, PhD, Hans Wedel, PhD^||, John Wikstrand, MD, PhD for the MERIT-HF Study Group¹

^* Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA
Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
Section of Cardiology, Rikshospitalet, Oslo, Norway
^|| Nordic School of Public Health, Göteborg, Sweden

View larger version (20K): [in a new window]   Figure 1 Kaplan-Meier curves of cumulative percentage of all-cause mortality (top), sudden deaths (middle) and deaths from worsening heart failure (bottom). CR/XL = controlled release/extended release.

View larger version (22K): [in a new window]   Figure 2 Kaplan-Meier curves of cumulative percentage of the combined end points (time to first event) of all-cause mortality or all-cause hospitalization (top), all-cause mortality or hospitalization for worsening chronic heart failure (CHF) (middle) and for cardiac death or nonfatal acute myocardial infarction (MI) (bottom). CR/XL = controlled release/extended release.

View larger version (32K): [in a new window]   Figure 3 (Upper) Total number of hospitalizations all-cause due to cardiovascular (CV) causes and due to worsening heart failure in the two randomization groups. Percentage figures are normalized for patient years of follow-up. (Lower) Total number of patients with permanent withdrawal of study drug due to any cause, due to any adverse event and due to worsening heart failure in the two randomization groups. Percentage figures are normalized for patient years of follow-up. CHF = chronic heart failure; CR/XL = controlled release/extended release.

View larger version (25K): [in a new window]   Figure 4 Point estimates for hazard ratios and 95% confidence intervals for total mortality for subgroups of patients with severe heart failure (New York Heart Association [NYHA] functional class III/IV and ejection fraction [EF] <0.25) in the CIBIS II study and the MERIT-HF study. Data for the COPERNICUS trial are also given together with pooled data. Number of deaths and number of patients in each randomization group, mean EF and yearly placebo (Plac) risk defined as deaths/patient years of follow-up are also given by study and for the pooled data. CI = confidence interval; n = 3,836.