Is There a Role for Beta-Blockers in Heart Failure Patients?

Abstract

On initial reflection, consideration of beta-blockade in the therapy of heart failure (HF) patients seems paradoxical. In most discussions of the therapeutics of congestive heart failure, beta-blockers are listed as contraindicated, given their known negative inotropic potential. The general perception that beta-blockers are contraindicated is adequately supported by clinical anecdotes, in which the administration of beta-blocker therapy (usually intravenously) in patients with acute or subacute and medically uncompensated HF has led to dramatic adverse reactions such as acute pulmonary edema and low output syndrome with hypotension and shock. Thus, the consideration of beta-blockade for therapy of HF patients would appear heretical based on conventional medical wisdom. Nevertheless, standard therapy for HF, while controlling symptoms in the short term, appears to have had little impact on the dismal natural history of the disease (1–4). Given this poor prognosis, the testing of new and unconventional approaches to chronic HF is appropriate. In this regard, it is of interest that despite the obvious danger in administering intravenous and full-dose beta-blocking drugs in acute HF, giving carefully titrated oral doses to patients with medically compensated, chronic HF is gaining increasing clinical and experimental support.