Tolerability of beta-blockers in elderly patients with chronic heart failure: The COLA II study

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. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.