beta-Blocker therapy in heart failure: scientific review. JAMA 2002 Feb 20;287(7):883-9
Date
02/20/2002Pubmed ID
11851582DOI
10.1001/jama.287.7.883Scopus ID
2-s2.0-0037138797 (requires institutional sign-in at Scopus site) 295 CitationsAbstract
CONTEXT: Care of patients with heart failure has been revolutionized throughout the past decade. A paradigm shift in the strategy for treating heart failure caused by systolic dysfunction is in progress. Despite the initial perception about beta-blockers' safety, they are now the most extensively studied class of agents in the treatment of heart failure and have emerged as an important intervention to improve the clinical outcomes of heart failure patients.
OBJECTIVE: To provide scientific rationale for the use of beta-blockers for patients with heart failure.
DATA SOURCES: All English-language articles of large, randomized controlled clinical trials assessing the mortality benefits of beta-blockers in patients with heart failure were identified to provide the scientific rationale for the use of beta-blockers in heart failure. Basic science studies were reviewed to provide an overview of the potential physiologic role of beta-blockers in heart failure. Finally, clinical guidelines for the treatment of patients with heart failure were assessed to determine current recommendations for the use of these agents.
STUDY SELECTION AND DATA EXTRACTION: Randomized controlled clinical trials of beta-blockers that included more than 300 subjects and assessed mortality as a primary end point.
DATA SYNTHESIS: Of the 4 beta-blockers tested in large randomized controlled clinical trials of patients with heart failure, 3 are available in the United States, bisoprolol, carvedilol, and metoprolol; 2 of these, carvedilol and metoprolol, have Food and Drug Administration indications for the treatment of heart failure. Compared with placebo treatment, beta-blocker use is associated with a consistent 30% reduction in mortality and a 40% reduction in hospitalizations in patients with class II and III heart failure.
CONCLUSIONS: Tested in more than 10,000 patients, beta-blockers reduce morbidity and mortality in class II through IV heart failure. Along with angiotensin-converting enzyme inhibitors, digoxin, and diuretics, beta-blockers have strengthened the armamentarium to improve clinical outcomes of heart failure patients. The science supporting beta-blockers must be translated into practice safely and rationally if the agents are to achieve their full potential.
Author List
Foody JM, Farrell MH, Krumholz HMMESH terms used to index this publication - Major topics in bold
Adrenergic beta-AntagonistsAnimals
Heart Failure
Humans
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Research
Ventricular Dysfunction, Left
