Beta-Blockade for Heart Failure: What to Aim For?

A meta-analysis suggests that improvements in mortality with beta-blockers are more strongly associated with the heart rate achieved than with dose.

Practice guidelines for treatment of systolic dysfunction strongly recommend titrating beta-blockers to doses used in published randomized trials. Achieving this goal is often challenging in practice, because the adverse effects of beta-blockade are largely dose-related. To explore whether the benefits of beta-blockade for heart failure relates to the reduction in heart rate, even at lower-than-target doses, investigators conducted a meta-analysis of 23 randomized trials of beta-blockers in patients with heart failure.

All-cause mortality was reported in all trials, and virtually all patients had systolic dysfunction (96%) and were receiving ACE inhibitors (93%). In four trials, beta-blockade conferred a significant survival benefit; in all …

Reviewing Author

Frederick A. Masoudi, MD, MSPH

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)