Korean J Intern Med.  2019 Sep;34(5):1030-1039. 10.3904/kjim.2018.009.

The mortality benefit of carvedilol versus bisoprolol in patients with heart failure with reduced ejection fraction

  • 1Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea. choijean5@gmail.com
  • 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 5Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 6Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 8Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 9Heart Research Center of Chonnam National University, Gwangju, Korea.
  • 10Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 11National Institute of Health (NIH), Osong, Korea.


It is unknown whether different β-blockers (BBs) have variable effects on long-term survival of patients with heart failure with reduced ejection fraction (HFrEF). This study compares the effects of two BBs, carvedilol and bisoprolol, on survival in patients with HFrEF.
The Korean Acute Heart Failure (KorAHF) registry is a prospective multicenter cohort that includes 5,625 patients who were hospitalized for acute heart failure (AHF). We selected 3,016 patients with HFrEF and divided this study population into two groups: BB at discharge (n = 1,707) or no BB at discharge (n = 1,309). Among patients with BB at discharge, subgroups were formed based on carvedilol prescription (n = 831), or bisoprolol prescription (n = 553). Propensity score matching analysis was performed.
Among patients who were prescribed a BB at discharge, 60.5% received carvedilol and 32.7% received bisoprolol. There was a significant reduction in all-cause mortality in those patients with HFrEF prescribed a BB at discharge compared to those who were not (BB vs. no BB, 26.1% vs. 40.8%; hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.52 to 0.67; p < 0.001). However, there was no significant difference in the rate of all-cause mortality between those receiving different types of BB (carvedilol vs. bisoprolol, 27.5% vs. 23.5%; HR, 1.21; 95% CI, 0.99 to 1.47; p = 0.07). Similar results were observed after propensity score matching analysis (508 pairs, 26.2% vs. 23.8%; HR, 1.10; 95% CI, 0.86 to 1.40; p = 0.47).
In the treatment of AHF with reduced EF after hospitalization, mortality benefits of carvedilol and bisoprolol were comparable.


Beta-blocker; Heart failure with reduced ejection fraction; Carvedilol; Bisoprolol
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