Benefits of inpatient initiation of beta-blockers.
Clinical trials have demonstrated that beta-blockers effectively reduce mortality in patients after a myocardial infarction (MI) and in patients with chronic heart failure. Treatment guidelines recommend that all patients after MI without a contraindication receive early beta-blocker treatment. Initiation of beta-blockers also should be considered for stable patients who are hospitalized with heart failure. Despite well-documented benefits, however, beta-blockers are still underused. Barriers that cause reluctance by physicians to initiate therapy include the traditional belief that beta-blockers are contraindicated in patients with left ventricular dysfunction, complexity of management, perceived risk of adverse events, and potential for short-term clinical deterioration. Intervention programs promoting beta-blockers for inpatients have increased their use at discharge and after long-term follow-up. Because of pharmacologic differences, agent selection is also critical. Agents must have proven clinical efficacy, an established dose-titration regimen, and desirable pharmacokinetic properties. Increasing the use of these life-saving agents has the potential for substantial clinical impact.
Ventura
Hector O
HO
Ochsner Clinic Foundation, New Orleans, LA 70121, USA. hventura@ochsner.org <hventura@ochsner.org>
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000075202:Contraindications; D003645:Death, Sudden / Q000517:prevention & control; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D055502:Secondary Prevention; D018487:Ventricular Dysfunction, Left / Q000150:complications
D000319:Adrenergic beta-Antagonists