To determine whether carvedilol can be safely up-titrated before hospital discharge, we studied 372 consecutive patients with systolic heart failure who were being treated with carvedilol. Carvedilol was initiated a median of 3 days after admission, with a mean starting dose of 12 mg. Up-titration was performed in 67% of patients, with a mean increase of 16 mg and a mean discharge daily dose of 23 +/- 17 mg. Mean daily dose at the end of follow-up was 35.3 +/- 25.3 mg and it increased with higher discharge dose.