Rationale for Treatment of Patients With Chronic Heart Failure With Adrenergic Blockade

OBJECTIVE: Chronic heart failure is the leading cause of hospital admissions in patients older than 65 years. Heart failure due to systolic dysfunction is accompanied by activation of the sympathetic nervous system that contributes to progressive symptoms and an increased risk of death. While several clinical trials have suggested that antagonizing this sympathetic activation with beta-blocking agents may provide clinical benefit, no clear consensus exists regarding use of beta-blockers for congestive heart failure. Therefore, we review the pathophysiology of the sympathetic nervous system as a basis for examining these clinical trials in order to understand the rationale for beta-blockade as a treatment for heart failure. DATA SOURCE: English language journal articles and reviews from a MEDLINE search and abstracts published at major cardiology meetings that related either to pathophysiology of the sympathetic nervous system or to therapy of patients with chronic heart failure with beta-blockers. STUDY SELECTION: Uncontrolled trials describing the initial use of this therapy and the subsequent randomized, placebo-controlled trials of beta-blockers were included. CONCLUSIONS: Sympathetic nervous system activation in patients with chronic heart failure is a major contributor to the severity of disease as well as its progression over time. Antagonism of its effects, via beta-blocker therapy, appears overall to improve both quality of life and survival. However, its place as a cornerstone in the therapy of this disease depends on the results of large-scale, randomized, placebo-controlled trials.