Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure

The use of β-blockers for the treatment of heart failure in the United States is inadequate, despite available data and current guidelines that support their use. The Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) study was designed to determine whether initiation of β-blockade before hospital discharge is safe and effective in improving the 60-day use of β-blockers in patients with heart failure. IMPACT-HF compared the strategy of the initiation of carvedilol before patients were discharged versus usual care (Heart Failure Society of America guidelines recommend waiting 2 to 4 weeks after hospitalization for heart failure before initiating β-blocker therapy) in 363 randomized patients with heart failure. The entry criteria were nonrestrictive to ensure inclusion of patients reflective of the general heart failure population. The primary end point of the study (the number of patients treated with any β-blocker at 60 days) was statistically significantly higher in the predischarge group versus the postdischarge group (91.2% vs 73.4%, respectively). Based on the studyʹs results, predischarge initiation may be a successful strategy to improve the use of β-blocker therapy for patients with heart failure.