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Beta-blockers are often contraindicated in heart failure, but some studies have shown a benefit in patients with severe cardiomyopathy. This report describes the outcome of beta-blocker therapy in 44 patients with ischemic or idiopathic dilated cardiomyopathy and ejection fractions of 20 percent or less.
All patients received digitalis, diuretics, and angiotensin-converting-enzyme inhibitors to improve congestive failure. Beta-blocker therapy was added in slow increments (6.25 to 12.5 mg of metoprolol or 5 to 10 mg of propranolol two or three times daily). Only one patient stopped therapy due to bradycardia. Eleven patients died during the study; 9 had sudden deaths.
The mean ejection fraction increased from 13 percent to 25 percent during 3 …