6/28/23, 12:15 AM COMET Pathway Feedback Search Clinical Topics Home Studies COMET COMET Disease Heart failure Trial question Is carvedilol superior to metoprolol on clinical outcomes in patients with chronic HF? Study design Multi-center Double blinded RCT Population Characteristics of study participants 20.0% female N = 3029 80.0% male 3029 patients (612 female, 2417 male) Inclusion criteria: patients chronic HF (NYHA II-IV), previous cardiovascular admission, and LVEF < 35% on optimal medical treatment Key exclusion criteria: contraindication to use of -blockers, history of asthma or COPD, peripheral arterial disease with symptoms at rest, or unstable insulin-dependent diabetes mellitus Interventions N=1511 carvedilol (target dose 25 mg BID) N=1518 metoprolol (target dose 50 mg BID) Primary outcome All-cause death 40.0 % 40 34 https://web.pathway.md/studies/recsNr6cfMRquAO4E 1/2 6/28/23, 12:15 AM COMET Pathway 30.0 % 20.0 % Significant decrease 10.0 % NNT = 17 0.0 % Carvedilol Metoprolol Significant decrease in all-cause death (34% vs. 40%; HR 0.83, 95% CI 0.74 to 0.93) Secondary outcomes No significant difference in death or hospital admission (74% vs. 76%; HR 0.94, 95% CI 0.86 to 1.02) Safety outcomes No significant difference in incidence of side-effects and drug withdrawals. Conclusion In patients chronic HF (NYHA II-IV), previous cardiovascular admission, and LVEF < 35% on optimal medical treatment, carvedilol was superior to metoprolol with respect to a all-cause death. Reference Poole-Wilson PA, Swedberg K, Cleland JG et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003 Jul 5;362(9377):7-13. Open reference URL https://web.pathway.md/studies/recsNr6cfMRquAO4E 2/2