The Impact of the B-blocker, Carvedilol in the Treatment of Heart Failure Patients in Komfo Anokye Teaching Hospital, Kumasi

The study was carried out to determine the impact of the inclusion of the β- blocker, carvedilol, a “third generation” β-blocker with α-vasodilating properties, to the standard treatment guidelines for heart failure, on mortality and length of hospital stay. The updated treatment guidelines were adopted and implemented at the medicine directorate of the Komfo Anokye Teaching Hospital in January, 2006 based on the updated treatment guidelines of the American College of Cardiologists, American Heart Association, Heart Failure Society of America and European Society of Cardiology. These guidelines recommend heart failure in-patients receiving an Angiotensin-Converting-Enzymes Inhibitor and/or Angiotensin-Receptor-Blocker, a Diuretic, a β-Blocker and an Aldosterone-Antagonist. The study took into consideration the age and sex distribution of the patients, their conditions on admission and the causes of heart failure presented at the medical wards. It was retrospective, covering a four-year period. The period of study was divided into two i.e. January 2004 to December 2005 before the implementation of updated treatment guidelines and January 2006 to December 2007 after its implementation. All heart failure patients who fell within these periods were used.The setting was the medicine directorate of Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa. The study involved 411 heart failure patients consisting of 233 males and 178 females. The ages of the patients admitted with heart failure during the period under review ranged from 13 to 100 years. The median age of the patients was 57.6 years with a standard deviation (SD) of 18.12. The male patients constituted 56.7% whiles 43.3% were female patients, the disease affecting more males than females during the period under review. The main causes of heart failure were hypertension (60.3% n=248), dilated cardiomyopathy (23.4% n=96), and valvular disease (4.6% n=19). Other conditions seen in patients were anaemia (0.49% n=2) and cardiogenic shock (1.9% n=8). Conditions of the patients on admission described as conscious/stable constituted 70.8%; conscious/unstable 27.7% and unconscious/unstable 1.5%. The implementation of the updated treatment guidelines with the β-blocker, carvedilol included led to a drastic reduction in overall mortality from 35.27% to 17.16% representing an 18.11% decrease in mortality or 50% improvement.The patients’ mean length of hospital stay was 5.1 days before its implementation and 3.2 days after its implementation representing 62.7% decrease. Almost all the patients received the loop diuretic, frusemide (97.8% n=402). The ACE-inhibitor, lisinopril, was used in 49.6% (n=204) of the patients, the aldosterone-antagonist, spironolactone was used in 45.8% of the patients (n=188) and the β-blocker, carvedilol was used in 22.4% (n=92) of the patients. In conclusion, the implementation of the updated treatment guidelines for heart failure in January 2006 which included the β-blocker, carvedilol led to a significant reduction in mortality, length of hospital stay and overall improvement in the quality of life of heart failure patients. The loop diuretic, frusemide and the ACE-inhibitor, lisinopril and the aldosterone-antagonist, spironolactone were commonly used whiles the β-blocker, carvedilol, was woefully underutilized.

Source: KNUST