Key result
Bucindolol shows no survival benefit in HF, reinforcing preference for carvedilol, metoprolol, and bisoprolol.
Why the study?
Bucindolol did not reduce overall survival in heart failure unlike other beta-blockers, and the reasons for this difference were unclear.
Does bucindolol improve overall survival in patients with heart failure compared to other beta-blockers?
Does bucindolol improve overall survival in patients with heart failure compared to other beta-blockers?
Bucindolol is not the optimal beta-blocker for heart failure; carvedilol, metoprolol, and bisoprolol should be preferred.
Racial or ancillary differences may explain bucindolol's BEST results; leaves open optimal β-blocker selection in diverse HF populations.
Carvedilol, a non-selective β-adrenoceptor blocker with ancillary properties, and metoprolol and bisoprolol, selective β1-blockers without ancillary properties, have been shown to reduce mortality and morbidity in heart failure. In the Beta-blocker Evaluation of Survival Trial (BEST), bucindolol, a non-selective β-adrenoceptor blocker with different ancillary properties to carvedilol, did not reduce overall survival in heart failure. Possible explanations for this include: more Blacks being included in the trial, bucindolol being more ‘sympatholytic’ than the other β-blockers and more advanced heart failure in BEST. Another possible explanation is that bucindolol is stimulating cardiac β2-adrenoceptors to counter the effects of inhibiting cardiac β1-adrenoceptors. Bucindolol is not the best treatment and carvedilol, metoprolol and bisoprolol should be preferred in heart failure.
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Sheila A Doggrell (2001) conducted a review in heart failure. Bucindolol was evaluated on overall survival. Bucindolol did not reduce overall survival in heart failure in the BEST trial, suggesting that carvedilol, metoprolol, and bisoprolol should be preferred.
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