title: Beta-blockers for heart failure: an evidence based review answering practical therapeutic questions.
abstract: Beta-blockers are underutilised in heart failure because clinicians may be unsure whether all beta-blockers are useful, how therapy should be initiated and whether beta-blockers are contraindicated in some patients. Bisoprolol, carvedilol and metoprolol succinate have been clearly proven to reduce mortality and hospitalisation in patients with Class II to IV heart failure; limited evidence also support short-acting metoprolol tartrate and nebivolol. Initiating dose should be very low (1.25 mg bisoprolol, 3.125 mg carvedilol, 12.5 mg metoprolol succinate) and increased gradually over weeks. Treatment benefit appears proportional to magnitude of heart rate reduction and thus target dose should be the maximum tolerated for adequate bradycardia. Even in decompensated heart failure or those with coexisting bronchospasm, beta-blockers are not contraindicated although the dose may have to be reduced or withheld temporarily. The consistent trial data should reassure clinicians and encourage them to confidently initiate beta blockers in patients with systolic heart failure.
authors.affiliation: HT Ong Heart Clinic, Cardiology, 251C Burma Road, Georgetown, Penang 10350, Malaysia. ongheanteik@gmail.com
authors.forename: H T
authors.initials: HT
authors.lastname: Ong
authors.forename: L M
authors.initials: LM
authors.lastname: Ong
authors.forename: F P
authors.initials: FP
authors.lastname: Kow
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000075202:Contraindications; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans
chemical_list: D000319:Adrenergic beta-Antagonists