Beta blocker therapy, decompensated heart failure, and inotropic interactions: current perspectives.
Beta blockers are a fundamental treatment in chronic heart failure (HF), yet concern and disagreement regarding their role in the treatment of decompensated HF and during hospitalization are common in clinical practice. This review summarizes the literature on various aspects of beta blocker treatment during acute and chronic decompensated HF. In recent years evidence has accumulated concerning the efficacy and tolerability of beta blockers in decompensated HF. Clinical analyses show that withdrawal of chronic beta blockade should be avoided when possible during hospitalization and that beta blockertherapy be initiated as soon as hemodynamic stability and a euvolemic state are achieved. This strategy may increase adherence to beta blockers after discharge and lower rehospitalization and mortality rates. We also discuss the various positive inotrope regimens (phosphodiesterase inhibitors, levosimendan, dobutamine) and their interactions with beta blockers in decompensated HF.
Department of Cardiovascular Medicine, Carmel Medical Center and Heart Failure Center, Lin Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. barakz@bezeqint.net
Barak
B
Zafrir
Offer
O
Amir
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D002908:Chronic Disease; D004280:Dobutamine / Q000008:administration & dosage / Q000494:pharmacology; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000494:pharmacology; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology; D017410:Practice Guidelines as Topic; D011724:Pyridazines / Q000008:administration & dosage / Q000494:pharmacology; D000077464:Simendan
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D006835:Hydrazones; D010726:Phosphodiesterase Inhibitors; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine