MERIT-HF

Is conventional therapy plus metoprolol CR/XR once daily superior to conventional therapy alone in patients with HF, a LV ejection fraction < 40%, and NYHA class II-IV symptoms?

Study design

Population

3991 patients (898 female, 1693 male)
Inclusion criteria: patients with HF, an LV ejection fraction s 40%, and NYHA class II-IV symptoms
Key exclusion criteria: acute myocardial infarction or unstable angina within 28 days before randomization; indication or contraindication for treatment with beta blockers, HF secondary to systemic disease or alcohol abuse; or AV block of the second and third degree

Interventions

N=1990 conventional therapy plus metoprolol CR/XR once daily (12.5 mg for NYHA III-IV or 25.0 mg once daily for NYHA lI, target dose 200 mg once daily plus optimum standard therapy)
N=2001 placebo (conventional therapy alone)

Primary outcome

Significant decrease in all-cause death (7.2% VS. 11%; RR 0.66, 95% CI 0.53 to 0.81)

Secondary outcomes

Significant decrease in SCD (0.19% vs. 0.132%; RR 0.59, 95% CI 0.28 to 0.9)
Significant decrease in worsening HF (0.3% vs. 0.58%;
RR 0.51, 95% CI 0.33 to 0.79)

Conclusion

In patients with HF, an LV ejection fraction s 40%, and NYHA class II-IV symptoms, conventional therapy plus metoprolol CR/XR once daily was superior to placebo with respect to a all-cause death.