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Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.
Open Access
Review
The Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) Study: Design and Implications
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Department of Medicine, Divisions of Clinical Pharmacology and Cardiology, Duke University Medical Center, Durham, NC
67
Rev. Cardiovasc. Med. 2002, 3(S3), 48–54;
Published: 20 May 2002
Abstract
The utilization of β-blockers for the treatment of heart failure in the United States is
inadequate despite the available data and the current guidelines that support their use.
The ongoing Initiation Management Predischarge Process for Assessment of Carvedilol
Therapy for Heart Failure (IMPACT-HF) study was designed to determine if initiation of
ß-blockade prior to hospital discharge is safe and effective in improving the 60-day use
of ß-blockers in patients with heart failure. IMPACT-HF is a community-based, multicenter,
open-label trial of 375 heart failure patients randomized to carvedilol initiated before their
hospital discharge or to usual care (Heart Failure Society of America guidelines that recommend
waiting 2–4 weeks after hospitalization for heart failure before initiating ß-blocker
therapy). The entry criteria are nonrestrictive to ensure inclusion of patients reflective of
the general heart failure population. The primary endpoint of the study is the number of
patients treated with any ß-blocker at 60 days. A concurrently ongoing pilot registry will
enroll 550 patients, admitted with exacerbated heart failure, in three phases to collect
demographic, clinical, treatment patterns, and outcome data. The trial will test the tolerability
of ß-blocker initiation in the hospital setting, develop strategies to improve the use of
evidence-based medicine in clinical practice, and explore the patient’s course from hospital
admission through discharge and up to 60 days. The trial data will determine if in-hospital
initiation of ß-blocker therapy is effective at improving the long-term use of pharmacologic
agents proven to reduce morbidity and mortality.
Keywords
Beta-blocker therapy
Heart failure
IMPACT-HF trial
Evidence-based medicine
Community-based practice