The safety and tolerability of beta blockers in heart failure with reduced ejection fraction: is the current underutilization of this evidence-based therapy justified?
BACKGROUND
Beta blockers are one of the cornerstones for treatment of Heart Failure with Reduced Ejection fraction (HFRef), yet their use is often limited by adverse effects, either perceived or real. We performed a review of available data using PubMed.gov utilizing beta blocker, heart failure, reduced ejection fraction and safety as key words.


METHODS
Several well designed, large scale randomized clinical trials including CIBS-II (bisoprolol), MERIT-HF (metoprolol succinate), and Copernicus (carvedilol) among others, have been conducted in patients with HFRef and demonstrated an improvement in cardiac mortality and morbidity. Despite the preponderance of data supporting the use of beta blockers for patients HFRef, these medications remain underutilized and/or are often prescribed at lower than recommended dosages. Some of the reluctance to embrace beta blockade may be attributed to concern on the part of both the patient and prescriber about the non-cardiac adverse effects of this class of drugs. We have reviewed several recent reviews and meta-analyses of trials of beta blocker in heart failure which have conclusively demonstrated their tolerability in the populations studied.


CONCLUSIONS
In the final section of this paper we provide our opinions regarding initiating and optimizing beta blocker therapy for patients with HFRef.
a Adult Cardiovascular Disease Fellow, University of California San Francisco - Fresno Medical Education Program - Department of Cardiology , Fresno , CA 93701 , USA.
Richard G
RG
Kiel
b Professor of Medicine University of California San Francisco, Director of Heart Failure Services, University of California Fresno - Fresno Medical Education Program - Department of Cardiology , Fresno , CA 93701 , USA.
Prakash
P
Deedwania
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D000319:Adrenergic beta-Antagonists
CHF; adverse drug effects; beta blockade; beta blockers; congestive heart failure; heart failure with reduced ejection fraction; medical therapy; safety