© 2005 European Society of Cardiology
Tolerability of beta-blockers in elderly patients with chronic heart failure: The COLA II study
a NHMRC Centre for Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University 3rd Floor, Burnet Tower, AMREP Precinct, Commercial Road, Melbourne Vic 3004, Australia
b Roche Pharmaceuticals Pty Ltd NSW, Australia
c Department of Internal Medicine, Division of Cardiology Graz, Austria
d SZTE AOK I Belklinika, Hungary
e Zhong Shan Hospital Shanghai, China
f Sanatorio Parque Rosario, Argentina
g Atrium Medical Centre Heerlen, The Netherlands
* Corresponding author. Tel.: +61399030042; fax: +61399030556. E-mail address: henry.krum{at}med.monash.edu.au (H. Krum).
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Abstract |
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Background: Beta-blockers are recommended therapy for patients with chronic heart failure (CHF). However, there remains concern regarding tolerability of these agents in the elderly, which has contributed to the limited uptake of these agents in clinical practice.
Aims: We conducted a multi-national, prospective evaluation of tolerability to carvedilol in 1030 CHF patients aged >70 years selected by their treating physician to receive this agent in everyday practice.
Methods and Results: NYHA Class II–IV CHF patients were assessed at baseline for key demographic parameters that may predict tolerability, then followed for 6 months after starting carvedilol. Tolerability was defined as being on 
6.25 mg bd of carvedilol at 6 months having received a total of 3 months therapy. Tolerability overall was 80% with age 70–75 years 84.3%, 76–80 years 76.8% and >80 years 76.8%. Mean carvedilol dose achieved was 31.2 mg. In multivariate analysis, advanced age, low diastolic BP, LVEF, obstructive airways disease and presence of diabetes were predictors of tolerability.
Conclusions: Carvedilol appears to be well tolerated in this elderly CHF patient cohort. Therefore, elderly CHF patients should not be denied treatment with carvedilol because of concerns regarding tolerability.
Key Words: Beta-blocker • Tolerability • Elderly
Received March 17, 2005; Revised May 31, 2005; Accepted August 17, 2005
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