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Beta-blockers in heart failure: how far have we progressed?

Authors
  • Adams, Kirkwood F
Type
Published Article
Journal
Postgraduate medicine
Publication Date
Nov 01, 2002
Volume
112
Issue
5 Suppl Unanswered
Pages
7–15
Identifiers
DOI: 10.3810/pgm.11.2002.suppl22.115
PMID: 19667603
Source
Medline
License
Unknown

Abstract

Beta-blockers, once considered contraindicated in patients with heart failure, are now the standard of care in such patients. This change is the result of several large-scale clinical trials, including Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF), and the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial, that have demonstrated significant morbidity and mortality benefits of beta-blockers in patients with heart failure caused by left ventricular systolic dysfunction. beta-blockade also improves quality of life and causes regression of cardiac remodeling, a phenomenon characteristic of chronic heart failure. This article provides an overview of the history of beta-blockade in the treatment of heart failure, beginning with the early misconception that beta-blockers are detrimental to patients with heart failure. Mechanistic and early clinical trials are reviewed, along with the results from CIBIS-II, MERIT-HF, and COPERNICUS. Barriers to the use of beta-blocker therapy also are discussed.

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