Special considerations for carvedilol use in heart failure

Remarkable improvements in morbidity and mortality caused by heart failure have been realized because of a greater understanding of the pathobiologic mechanisms of left ventricular dysfunction and the subsequent application of neurohormonal antagonism to the heart failure milieu. The median survival of patients with chronic heart failure has greatly increased with the use of effective medical therapy that includes angiotensin-converting enzyme inhibitors and β-blockers, especially carvedilol. Still to be addressed is the issue of clinical trials that underrepresent special populations of patients who are affected with heart failure (eg, the elderly, women, and African Americans). Even though heart failure may be a somewhat different illness in etiology, epidemiology, or responsiveness to medical therapy for each of these groups, it is of utmost importance that patients affected by heart failure be treated with agents that have been shown to be of benefit in the major controlled clinical trials in heart failure.