Use of beta-blockers in congestive heart failure

WhileWhile b b-adrenergic blockers have been used for -adrenergic blockers have been used for decades in a variety of cardiovascular illnesses, they decades in a variety of cardiovascular illnesses, they have traditionally been avoided in chronic heart have traditionally been avoided in chronic heart failure.In spite of signicant advances in manage-failure.In spite of signicant advances in management, mortality in patients suffering from heart ment, mortality in patients suffering from heart failure remains unacceptably high and new therapies failure remains unacceptably high and new therapies are urgently needed.Recently, several large clinical are urgently needed.Recently, several large clinical trials have shown a signicant reduction in both trials have shown a signicant reduction in both morbidity and mortality in heart failure patients when morbidity and mortality in heart failure patients when b b-blockers are added to standard therapy.While -blockers are added to standard therapy.While further investigation is warranted in certain sub-further investigation is warranted in certain subgroups, the use of groups, the use of b b-adrenergic blockers in New York -adrenergic blockers in New York Heart Association (NYHA) class II to IV heart failure Heart Association (NYHA) class II to IV heart failure should now be considered routine.The purpose of this should now be considered routine.The purpose of this article is to outline and review the ve major clinical article is to outline and review the ve major clinical trials of trials of b b-blocker therapy in chronic heart failure; the -blocker therapy in chronic heart failure; the US Carvedilol heart failure Program (USCP), the US Carvedilol heart failure Program (USCP), the Cardiac Insufciency Bisoprolol Study II (CIBIS-II), Cardiac Insufciency Bisoprolol Study II (CIBIS-II), the Metoprolol CR/XL Randomized Intervention Trial the Metoprolol CR/XL Randomized Intervention Trial in chronic Heart Failure (MERIT-HF), the Beta-blocker in chronic Heart Failure (MERIT-HF), the Beta-blocker Evaluation of Survival Trial (BEST) and the Carvedilol Evaluation of Survival Trial (BEST) and the Carvedilol Prospective Randomized Cumulative Survival trial Prospective Randomized Cumulative Survival trial (COPERNICUS), and to aid the reader in the selection (COPERNICUS), and to aid the reader in the selection of appropriate candidates for of appropriate candidates for b b-blocker therapy.-blocker therapy.