Comparison of Nebivolol with Metoprolol in controlling heart rate and improving left ventricular ejection fraction in patients with congestive cardiac failure

Abstract

Objective: To compare nebivolol versus metoprolol therapy in controlling heart rate and improvement in left ventricular ejection fraction in patients with congestive cardiac failure. Study Design: Randomized controlled trial. Place and Duration of Study: Out-patient department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad from 1 March 2016 to 28 February 2017. Materials and Methods: A total of 262 cases were included. A detailed clinical examination, electrocardiography and echocardiography were done by blinded operators. Randomization of patients into group A and group B via random number table was done. Group A received nebivolol and group B received metoprolol tartrate for six months. Patients of all age groups, of either gender or all socioeconomic strata, with the clinical diagnosis of cardiac failure were included in this study. Decompensation of heart failure requiring hospitalization and bradycardia or atrioventricular blocks developing during the study was taken as a criterion for drop out. History of diabetes, hypertension, and smoking was recorded. Left ventricular ejection fraction and heart rate were documented and compared amongst the two groups. Chi square test was applied for comparison between qualitative variables while the independent samples t-test was used to compare quantitative variables between groups. Analysis of data was done using SPSS version 21. A p-value of ≤ 0.05 was considered significant. Results: Our study population was 262 patients with a mean age of 49.25 + 31.74 years, range between 18 and 80 years. Patients in group A, on nebivolol demonstrated a significant improvement in left ventricular ejection fraction (p=0.00031) and heart rate (p=0.00163) when compared to patients in group B, on metoprolol. Conclusion: Nebivolol was found to more effective in improving left ventricular ejection fraction and heart rate in patients with congestive cardiac failure.