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Steve Cheung's avatar

There has NEVER been an RCT using metoprolol tartrate in HFrEF. And the dose of metoprolol succinate in MERIT-HF was 200mg ONCE daily.

Do you even see or treat HFrEF patients in a clinical setting?

The lesson from COMET: use a HF drug that actually has RCT data. At the dose tested. You might want to do a lit review.

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Anis Rassi Jr's avatar

It seems that you have a serious problem in understanding. Why I mentioned COMET? Because it was an unfair comparison between carvedilol and another beta blocker (tartrate of metoprolol) that should not be used in heart failure and also if you want to do a trial with this beta blocker use the correct maximum dose that is 100 mg twice a day and not 50 mg twice a day as it was done in COMET. So, the lesson from COMET are two: wrong drug AND WRONG DOSE. I did not say anything about MERIT HF. Got it now?

Yes I treat patients with HF. You probably do not as you do not know even how much valsartan has a tablet of 200 mg of entresto . This is your third mistake!

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Steve Cheung's avatar

You seem to have no grasp of evidence based medicine.

Why was COMET an unfair comparison? Because it compared one evidence-based BB (carvedilol) with another BB with absolutely no evidence basis in HFrEF (metoprolol tartrate). It would not have mattered WHAT dosage of metoprolol tartrate was used, since itтАЩs never been shown to be of outcome benefit in HFrEF AT ANY DOSE.

There is no RCT of metoprolol tartrate in HFrEF showing benefit EVER, ANYWHERE. AT ANY DOSE. When itтАЩs the wrong drug, the dose doesnтАЩt matter. Do you have evidence from an RCT showing that metoprolol tartrate at 100mg BID is the correct dose? Take your time. IтАЩll wait.

No, you didnтАЩt invoke MERIT HF, cuz IтАЩm not sure you realized the тАЬmetoprololтАЭ of COMET was different than the тАЬmetoprolol тАЬ of MERIT HF.

This might explain your foolhardy complaint about this Chagas trial and your fixation about dosage. The learning point from COMET is to compare evidence based regimens against each other, which COMET did not do. But they ARE doing so in the current trial in question, other glaring issues notwithstanding. Alternatively, do you have RCT evidence demonstrating that enalapril at 20mg BID provides outcome benefits? What is the evidence basis for your assertion?

IтАЩve already acknowledged my mistake. Seems you are not quite as capable on that front.

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