Evidence Based Snapshots

The Journal of Informed Pharmacotherapy 2003;14:150.

Comparison of Carvedilol and Metoprolol on Clinical Outcomes in Patients with Chronic Heart Failure in the Carvedilol or Metoprolol European Trial (COMET) Randomized Controlled Trial

Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
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Associate Editor, Journal of Informed Pharmacotherapy

Original Citation

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. Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, Lubsen J, Lutiger B, Metra M, Remme WJ, Torp-Pedersen C, Scherhag A, Skene A.  Lancet 2003;362:7-13 PubMed Citation

Overall Study Question

These investigators compared carvedilol to metoprolol in patients with chronic heart failure (CHF) and evaluated the impact on all-cause mortality and all-cause admission.


1511 patients with CHF (approximately 50% in both class II and class III) with a total cholesterol <6.5 mmol/L. Therapy for CHF prior to study enrollment included diuretics (99%), ACE inhibitors (92%), digoxin (60%), and lipid lowering agents (20%). The average age of the patients was 62 years and  20% were female. 


Patients were randomized in a blinded fashion to receive either carvedilol (25 mg PO BID) or metroprolol (50 mg PO BID). 


The mean study duration was 58 months.


There was no difference between groups in mean heart rate. The mean decrease in systolic blood pressure was 1.8 mmHg greater in the carvedilol group.

How does this study contribute to the drug therapy of patients with heart failure?

This study suggests that carvedilol reduces the chance of all deaths and cardiovascular deaths when compared to metoprolol in patients with Class II-III heart failure.  The combination of all overall deaths and all-cause admissions (one of the primary endpoints) and overall serious adverse events was not different between the two agents.

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