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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)

Cleland, JGF; Charlesworth, A; Lubsen, J; Swedberg, K; Remme, WJ; Erhardt, Leif RW LU ; Di Lenarda, A; Komajda, M; Metra, M and Torp-Pedersen, C, et al. (2006) In Journal of the American College of Cardiology 47(8). p.1603-1611
Abstract
OBJECTIVES This study was designed to investigate the loss of well-being, in terms of lift-years, overall and in patients randomized to metoprolol versus carvedilol in the Carvcdilol 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... (More)
OBJECTIVES This study was designed to investigate the loss of well-being, in terms of lift-years, overall and in patients randomized to metoprolol versus carvedilol in the Carvcdilol 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. (Less)
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Journal of the American College of Cardiology
volume
47
issue
8
pages
1603 - 1611
publisher
Elsevier USA
external identifiers
  • wos:000236819000014
  • pmid:16630997
  • scopus:33646048754
ISSN
0735-1097
DOI
10.1016/j.jacc.2005.11.069
language
English
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yes
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9030a1ca-917d-4fc1-90aa-9dd8ba750dbb (old id 693348)
date added to LUP
2007-12-21 13:08:26
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2019-07-14 03:31:22
@article{9030a1ca-917d-4fc1-90aa-9dd8ba750dbb,
  abstract     = {OBJECTIVES This study was designed to investigate the loss of well-being, in terms of lift-years, overall and in patients randomized to metoprolol versus carvedilol in the Carvcdilol 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 &lt; 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.},
  author       = {Cleland, JGF and Charlesworth, A and Lubsen, J and Swedberg, K and Remme, WJ and Erhardt, Leif RW and Di Lenarda, A and Komajda, M and Metra, M and Torp-Pedersen, C and Poole-Wilson, PA},
  issn         = {0735-1097},
  language     = {eng},
  number       = {8},
  pages        = {1603--1611},
  publisher    = {Elsevier USA},
  series       = {Journal of the American College of Cardiology},
  title        = {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)},
  url          = {http://dx.doi.org/10.1016/j.jacc.2005.11.069},
  volume       = {47},
  year         = {2006},
}