A group of investigators led by Dr Donatella Del Sindaco of the IRCCS INRCA in Rome, Italy, evaluated the long-term safety, tolerability, and efficacy of beta-blockers in elderly patients with chronic heart failure with or without diabetes. The investigators followed 252 patients aged 70 years or older with heart failure and left ventricular ejection fraction (LVEF) of 40% or less. The prevalence of diabetes was 29.7%. The beta-blocker carvedilol was given as part of standard treatment to 64% of patients with diabetes and to 65% of those without diabetes.

The investigators found that, after 1 year of follow-up, tolerability scores and mean daily dose of carvedilol were similar in patients with and without diabetes. Similar improvements in New York Heart Association class and mitral regurgitation severity were seen in both groups. Improvement in LVEF was significant in both groups but more pronounced in those without diabetes. Patients with diabetes treated with carvedilol had no worsening of glycaemic control or creatinine levels, or increase in mortality or hospitalization rates.

The investigators concluded that diabetes does not negatively influence the safety, efficacy, or tolerability of carvedilol in elderly patients. However, the presence of diabetes remains a prognostic factor limiting the reversibility of LVEF.

Journal of Cardiovascular Medicine 2007;8:675-82