Trial reportEuropean journal of heart failure2011
Titration to target dose of bisoprolol vs. carvedilol in elderly patients with heart failure: the CIBIS-ELD trial.
Trial report in European journal of heart failure, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
58 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Is Carvedilol Effective in Preventing and Modulating Concentric Cardiac Remodelling? A Comprehensive Systematic Review and Meta-Analyses.Cardiovascular therapeutics · 2025Pooled it
- Association of β-Blocker Use With Heart Failure Hospitalizations and Cardiovascular Disease Mortality Among Patients With Heart Failure With a Preserved Ejection Fraction: A Secondary Analysis of the TOPCAT Trial.JAMA network open · 2019Trial
- Regional differences in health-related quality of life in elderly heart failure patients: results from the CIBIS-ELD trial.Clinical research in cardiology : official journal of the German Cardiac Society · 2017Trial
- Trial
- Relationship of beta-blocker dose with outcomes in ambulatory heart failure patients with systolic dysfunction: results from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial.Journal of the American College of Cardiology · 2012Trial
- Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from the SHIFT echocardiography substudy.European heart journal · 2011Trial
- The Complex Relationship Between Heart Failure and Chronic Obstructive Pulmonary Disease: A Comprehensive Review.Journal of clinical medicine · 2025Review
- Perceptions of the Intensity of Heart Failure Medications among Hospitalized Older Adults: A Pilot Qualitative Study.Annals of geriatric medicine and research · 2025Article
- Heart Failure in Older Patients: An Update.Journal of clinical medicine · 2025Review
- Complexities in Geriatric Cardiology: Clinical Dilemmas and Gaps in Evidence.Journal of geriatric cardiology : JGC · 2025Article
- Heart Failure in Elderly Patients: Medical Management, Therapies and Biomarkers.Pharmaceuticals (Basel, Switzerland) · 2024Review
- Use and Benefit of Sacubitril/Valsartan in Elderly Patients with Heart Failure with Reduced Ejection Fraction.Journal of clinical medicine · 2024Article
- The median doses of beta-blockers among older adults with heart failure with reduced ejection fraction.Journal of the American Geriatrics Society · 2023Article
- How do we define high and low dose intensity of heart failure medications: a scoping review.BMC cardiovascular disorders · 2023Article
- Heart failure with reduced ejection fraction and atrial fibrillation: a Sub-Saharan African perspective.ESC heart failure · 2023Review
- The Population Comparison Index: An Intuitive Measure to Calibrate the Extent of Impairments in Patient Cohorts in Relation to Healthy and Diseased Populations.International journal of environmental research and public health · 2023Article
- JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias.Journal of arrhythmia · 2022Article
- Adherence and Discontinuation of Optimal Heart Failure Therapies According to Age: A Danish Nationwide Study.Journal of the American Heart Association · 2022Article
- Exploring the kinetic selectivity of drugs targeting the βPharmacology research & perspectives · 2022Article
- Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata.European journal of heart failure · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsVarious beta-blockers with distinct pharmacological profiles are approved in heart failure, yet they remain underused and underdosed. Although potentially of major public health importance, whether one agent is superior in terms of tolerability and optimal dosing has not been investigated. The aim of this study was therefore to compare the tolerability and clinical effects of two proven beta-blockers in elderly patients with heart failure. METHODS AND
resultsWe performed a double-blind superiority trial of bisoprolol vs. carvedilol in 883 elderly heart failure patients with reduced or preserved left ventricular ejection fraction in 41 European centres. The primary endpoint was tolerability, defined as reaching and maintaining guideline-recommended target doses after 12 weeks treatment. Adverse events and clinical parameters of patient status were secondary endpoints. None of the beta-blockers was superior with regards to tolerability: 24% [95% confidence interval (CI) 20-28] of patients in the bisoprolol arm and 25% (95% CI 21-29) of patients in the carvedilol arm achieved the primary endpoint (P= 0.64). The use of bisoprolol resulted in greater reduction of heart rate (adjusted mean difference 2.1 b.p.m., 95% CI 0.5-3.6, P= 0.008) and more, dose-limiting, bradycardic adverse events (16 vs. 11%; P= 0.02). The use of carvedilol led to a reduction of forced expiratory volume (adjusted mean difference 50 mL, 95% CI 4-95, P= 0.03) and more, non-dose-limiting, pulmonary adverse events (10 vs. 4%; P < 0.001).
conclusionOverall tolerability to target doses was comparable. The pattern of intolerance, however, was different: bradycardia occurred more often in the bisoprolol group, whereas pulmonary adverse events occurred more often in the carvedilol group. This study is registered with controlled-trials.com, number ISRCTN34827306.
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