Protocol for Switching from Metoprolol Tartrate to Carvedilol CR in Post-CABG Patients

Rationale for Switching

The American College of Cardiology recommends carvedilol as one of the three beta-blockers proven to reduce mortality in HFrEF patients, due to its additional alpha-1 blocking and vasodilatory properties 1

The American College of Cardiology suggests confirming patient is hemodynamically stable (systolic BP >90 mmHg, heart rate >60 bpm) before initiating the switch 1
The American Heart Association recommends ensuring patient is not in decompensated heart failure before initiating the switch 1
The American College of Cardiology advises to continue current diuretic therapy to maintain fluid balance during the transition 1

The American College of Cardiology recommends assessing tolerance after 1-2 weeks and doubling the dose every 2 weeks until reaching target dose 1
The American Heart Association suggests monitoring heart rate and blood pressure closely during titration 1, 2
The target dose for carvedilol CR in HFrEF is 40-80 mg once daily, as recommended by the American College of Cardiology 1

The American College of Cardiology recommends beta-blockers be reinstituted as soon as possible after CABG in all patients without contraindications to reduce the incidence of AFib 3
The American Heart Association advises ensuring adequate rate control (resting heart rate <80 bpm) for patients with persistent AFib 2
The American College of Cardiology suggests considering combination therapy with digoxin if rate control is inadequate with carvedilol alone 2
The American Heart Association recommends maintaining anticoagulation as appropriate based on CHA₂DS₂-VASc score 2

The American College of Cardiology recommends temporarily reducing the dose of carvedilol CR if hypotension occurs (SBP <90 mmHg) 1
The American Heart Association advises reducing carvedilol CR dose if bradycardia occurs (HR <55 bpm) 1, 2