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Despite current evidence-based guidelines that advocate beta-blocker use for all NYHA class I-IV patients with left-ventricular systolic dysfunction (unless contraindicated or not tolerated), rates of use remain unacceptably low. In a prospective, observational study, researchers analyzed beta-blocker use among 1041 new patients who were seen in a Canadian heart-failure clinic from September 1989 to July 2001. All patients (median age, 69; 65% men; mean LV ejection fraction, 33%) had confirmed NYHA class I-IV heart failure, 66% of ischemic etiology. Median follow-up was 32 months.
Of 765 patients who were not receiving beta-blockers at their first visit, 15% had contraindications. During the overall study period, 46% of new patients were pre…