Treatment of chronic heart failure with carvedilol in daily practice: The SATELLITE survey experience ☆ Mitja Lainscak a,b, ⁎ , Christine Moullet c , Norbert Schön d , Michal Tendera e a Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia b Division of Applied Cachexia Research, Department of Cardiology, Campus Virchow Clinic, Charité-Universitätsmedizin Berlin, Germany c F. Hoffmann-La Roche Ltd., Basel, Switzerland d Kardiologische Praxis Mühldorf am Inn, Germany e 3rd Division of Cardiology, Silesian School of Medicine, Katowice, Poland Received 26 October 2006; received in revised form 6 July 2007; accepted 11 August 2007 Available online 4 September 2007 Abstract Background: β-blockers are well established for treatment of chronic heart failure (CHF). However, the extent of implementation of trial results and guidelines in daily practice remains limited, and information regarding how patients feel is scarce. Methods: In this prospective observational survey of 6 months duration, 531 physicians from 10 countries recruited 3748 β-blockers untreated patients with CHF. We assessed the efficacy, tolerability and achieved dosage of carvedilol. In addition, patients assessed their well- being 3 times: at baseline, after 3 and 6 months of treatment. Results: Carvedilol was started in 3721 patients with CHF (median age 65 years, 60% men). NYHA class, clinical symptoms and signs, vital signs, 5-item well-being rating scale and visual analogue scale improved during the survey. Side effects, mostly fatigue, hypotension, and dizziness, were reported for 6.5% and 5% of patients at 3 and 6 months and carvedilol had to be discontinued in 63 patients. A total of 55 deaths (1.5%) and 520 hospitalisations in 466 patients (13%) were recorded. At 6 months the mean daily dose of carvedilol was 31 ± 11 mg; 25 mg/day was prescribed to 35% and 50 mg/day to 26% of patients. Conclusions: Initiation and up-titration of carvedilol in ambulatory care patients with CHF is feasible and safe. Its efficacy and tolerability were at least as good as in clinical trials, while the amelioration of patients' well-being was significant despite sub-optimal dosing. An additional effort should be done by physicians to treat their patients with CHF in daily practice with the recommended β-blockers at optimal doses. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: β-blocker; Carvedilol; Chronic heart failure; Efficacy; Tolerability 1. Background Major advances in chronic heart failure (CHF) management over the last two decades importantly influenced the recom- mendations for pharmacological therapy, especially for β- blockers [1–3]. For carvedilol, benefits were demonstrated over the entire spectrum of patients' functional status [4–6], or when compared with another β-blocker [7]. Furthermore, one study in patients with primarily left ventricular dysfunction and mild heart failure showed that the combination of carvedilol and an ACE inhibitor should be initiated early in these patients [8]. Albeit the adherence to guidelines predicts outcome in everyday clinical practice [9], many studies across Europe still report failure to implement β-blockers in patients with CHF [10–13]. Several reasons may contribute to current clinical practice of β-blockers use in patients with CHF. The patient population is generally dissimilar to that from the clinical trials, which must meet strict eligibility criteria and receives a higher standard of care during the trial [14]. In addition, due to the long-lasting belief that β-blockers are contraindicated in patients with CHF, International Journal of Cardiology 122 (2007) 149 – 155 www.elsevier.com/locate/ijcard ☆ Conflict of interest: M. Lainscak and N. Schön participated in the survey as investigators. C. Moullet is an employee of F. Hoffmann-La Roche Ltd. ⁎ Corresponding author. Department of Internal Medicine, General Hospital Murska Sobota, Dr. Vrbnjaka 6, SI-9000 Murska Sobota, Slovenia. Tel.: +386 31379533; fax: +386 25211007. E-mail address: mitja.lainscak@guest.arnes.si (M. Lainscak). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.08.001