Titration of carvedilol in elderly heart failure patients

Physicians may withhold beta blockers from elderly heart failure patients based on perceptions of poor tolerability in this group. This study analyzed the success and tolerability of carvedilol titration in elderly (70 years and older) and younger (younger than 70) heart failure patients (n =360). The mean duration of titration was similar in both groups. The target carvedilol dosage (50 mg/d) was achieved by 55.3% and 62.0%, and a partial dose was achieved by 44.7% and 35.5% (p =0.028) of elderly and younger patients, respectively. The mean achieved dosage was lower in elderly patients than in younger patients (42.4 +/- 27.2 mg/d vs. 55.1 +/- 30.1 mg/d; p < 0.0001), possibly due to significant between-group differences in baseline characteristics or rates of target dose achieved. When adjusted for body weight, the mean achieved dose was similar in elderly (0.58 +/- 0.32 mg/kg/d) and younger (0.64 +/- 0.30 mg/kg/d) patients (p =nonsignificant). Adverse events were more frequent in the elderly but did not appear to significantly impact titration duration or carvedilol dose achieved when corrected for body weight. In conclusion, carvedilol should not be withheld from elderly heart failure patients based on perceptions of poor potential tolerability.