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Systematic review and meta-analysis

This trial is included in the following systematic reviews and meta-analyses:

heart failure - beta-blockers - all type of heart failure


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Metra, 1994 - carvedilol vs placebo

Eichhorn, 1994 - metoprolol vs placebo

CIBIS, 1994 - bisoprolol vs placebo

Bristow, 1994 - Bucindolol vs placebo

MDC (Waagstein), 1993 - metoprolol vs placebo

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See also:

  • All heart failure clinical trials
  • All clinical trials of beta-blockers
  • All clinical trials of metoprolol
  •  

    MDC (Waagstein) study, 1993

    download pdf: metoprolol | beta-blockers for heart failure

    Treatments

    Studied treatment metoprolol target dose 100-150 mg daily (dose divided into two or three per day)
    the daily dose increased over 6 weeks from week 1 10mg, week 2 15mg, week 3 30 mg, week 4 50mg, week 5 75mg, week 6 100mg, week 7 and onwards 150mg
    Control treatment placebo
    Concomittant treatment digitalis, diuretics, ACE inhibitors, nitrates for a state of compensated heart failure
    Treatments description
    achieved dose 108 mg/ 115mg 
    open label beta-blockers NA 

    Patients

    Patients patient with heart failure due to idiopathic dilated cardiomyopathy (NYHA 1-3) and EF<40%
    Inclusion criteria age 1--75 years; synptomatic dilated cardiomyopathy and ejection fraction below à.40;
    Exclusion criteria treatment with beta-blockers, calcium antagonists, inotropic agent (except digitalis); significant coronary artery disease; myocarditis; other life threatening disease; obstructive lung disease; insulin dependant diabetes; heart rate<45/min; SBP<90mmHg
    Baseline characteristics
    Female (%) 27.5 
    Age (yr) 49  
    Cause of heart failure idiopathic dilated cardiomyopathy 
    NYHA class II-III 
    Ejection fraction, mean, % 0.22 
    inclusion heart rate 90/91 
    HR change (absolute) -9 (at 6 months, -5 at 12 months) 
    HR change (relative, %) NA 
    HR under treatment NA 
    EF selection <40% 
    NYHA 2 class 44.5 
    NYHA 3 class 49. 
    NYHA 4 class
    ischemic cause 0% 
    Idiopathic cause 100% 
    other cause 0% 
    ACE inhibitors (at inclusion), % 79.97 
    digitalis (at inclusion), % 78.49 
    spironolactone (at inclusion), % NA 
    vasodilatators (at inclusion), % 13.51 
    current angina NA 
    run-in phase No 

    Method and design

    Randomized effectives 194 / 189 (studied vs. control)
    Design Parallel groups
    Blinding Double blind
    Follow-up duration 18 months
    Lost to follow-up NA
    Number of centre 33
    Geographic area Europe, North America
    Hypothesis Superiority
    Primary endpoint death or transplantation waiting list
    Withdrawals (T1/T0) 23 (11.86%) / 31 (16.4%)


    Results

    Endpoint Studied treat.
    n/N
    Control treat.
    n/N
    Graph RR [95% CI]

    All cause death

    23 / 194
    21 / 189
    1,07 [0,61;1,86]

    Death from any cause or hospitalization for any reason

    48 / 194
    61 / 189
    0,77 [0,56;1,06]

    hospitalisation for heart failure

    37 / 194
    49 / 189
    0,74 [0,50;1,07]

    NYHA class improvement

    67 / 194
    52 / 189
    1,26 [0,93;1,70]
    0 2 1.0

    Relative risks
    Endpoint Events (%) Relative Risk 95% CI Endpoint definition
    in the trial
    Ref
    Studied treat. Control treat.
    All cause death 23 / 194 (11,9%) 21 / 189 (11,1%) 1,07 [0,61;1,86]  
    Death from any cause or hospitalization for any reason 48 / 194 (24,7%) 61 / 189 (32,3%) 0,77 [0,56;1,06]  
    hospitalisation for heart failure 37 / 194 (19,1%) 49 / 189 (25,9%) 0,74 [0,50;1,07]  
    NYHA class improvement 67 / 194 (34,5%) 52 / 189 (27,5%) 1,26 [0,93;1,70]  
    The primary endpoint (if exists) appears in blod characters
    Reference(s) used for data extraction:

    Endpoint studied treat. control treat. mean diff

    Absolute risk reduction
    Endpoint Events rate Absolute risk
    reduction (ARR)
    Studied treat. Control treat.
    All cause death 11,86% 11,11% 7,4‰
    Death from any cause or hospitalization for any reason 24,74% 32,28% -75,3‰
    hospitalisation for heart failure 19,07% 25,93% -68,5‰
    NYHA class improvement 34,54% 27,51% 7,0%

    Meta-analysis of all similar trials:

    beta-blockers in heart failure for all type of heart failure



    Reference(s)

    Trials register # NA
    • Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, Gilbert EM, Johnson MR, Goss FG, Hjalmarson A. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group.. Lancet 1993;342:1441-6
      Pubmed | Hubmed | Fulltext

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