Role of in-hospital initiation of carvedilol to improve treatment rates and clinical outcomes

Patients with heart failure face a very high risk of hospitalization and mortality. Despite compelling scientific evidence that beta-blockers reduce hospitalizations and mortality in patients with heart failure, this lifesaving therapy continues to be underused. Studies in a variety of clinical settings have documented that a significant proportion of patients with heart failure ore not receiving treatment with this guideline-recommended, evidence-based therapy when physicians are guided by conventional care. A similar treatment gap has been documented for lipid-lowering therapy in patients with coronary artery disease. It has been demonstrated that initiation of lipid-lowering and other cardiovascular protective medications before hospital discharge for atherosclerotic cardiovascular events results in a marked increase in treatment rates, improved long-term patient compliance, and better clinical outcomes. This has led to national guidelines being revised to endorse this approach as the standard of care. Recent studies demonstrate that carvedilol can be safely and effectively initiated in patients with heart failure before hospital discharge and that this improves clinical outcomes. Adopting in-hospital initiation of carvedilol as the standard of care for patients hospitalized with heart failure could dramatically improve treatment rates-thus substantially reducing the risk of future hospitalizations and prolonging life in the many patients with heart failure hospitalized each year. (C) 2004 by Excerpta Medica, Inc.