β-Blockers Improve Outcomes in Patients with Heart Failure and Low Left Ventricular Ejection Fraction

β-blockers improve symptoms and survival in patients with heart failure. However, β-blockers differ in their pharmacologic effects (e.g., adrenergic receptor selectivity), and which β-blocker is best for patients with heart failure is unclear. In this meta-analysis of randomized trials, investigators determined whether any specific β-blocker is superior to other β-blockers in patients with heart failure and low left ventricular ejection fraction (LVEF).

Overall, 21 trials that involved >23,000 patients (median age, 61; 77% men; median LVEF, 25%) were evaluated. β-blockers used in the trials were atenolol, bisoprolol, bucindolol (not FDA-approved), carvedilol, metoprolol, and nebivolol (Bystolic). After a median follow-up of 12 months, β-bloc…