MERIT-HF
Trial question
Is conventional therapy plus metoprolol CR/XR once daily superior to conventional therapy alone in patients with HF, a LVEF ≤ 40%, and NYHA class II-IV symptoms?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
23.0% female
77.0% male
N = 3991
3991 patients (898 female, 3093 male).
Inclusion criteria: patients with HF, an LVEF ≤ 40%, and NYHA class II-IV symptoms.
Key exclusion criteria: acute MI 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 II, target dose 200 mg once daily plus optimum standard therapy).
N=2001 placebo (conventional therapy alone).
Primary outcome
All-cause death
7.2%
11%
11.0 %
8.3 %
5.5 %
2.8 %
0.0 %
Conventional therapy plus metoprolol CR/XR once
daily
Placebo
Significant
decrease ▼
NNT = 26
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 LVEF ≤ 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.
Reference
MERIT-HF Study Group. Effect of metoprolol CR / XL in chronic heart failure: Metoprolol CR / XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999 Jun 12;353(9169):2001-7.
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