beta-blockers for congestive heart failure - What is the current consensus?

Despite the availability of angiotensin converting enzyme (ACE) inhibitors for patients with congestive heart failure (CHF), mortality and morbidity r emains unacceptably high. CHF is thought to progress as a result of activat ion of endogenous neurohormonal systems which are activated by the initial myocardial injury. The 2 neurohormonal systems which seem to be important i n CHF are the sympathetic nervous system (SNS), and the renin-angiotensin-a ldosterone system (RAAS). While stimulation of the SNS has important circul atory support functions in the short term. long term activation appears to have deleterious effects on cardiac function and outcomes. The purpose of t his article is to review the literature on the use of beta-blockers in pati ents with CHE. The published randomised clinical trials of beta-blockers in patients with CHF have shown very promising effects on mortality and morbidity. Several s ystematic overviews of these trials also suggest beneficial effects on mort ality, hospitalisation for CHF, need for transplant, and ejection fraction. The effect of beta-blockers on exercise tolerance, New York Heart Associat ion Function Class (NYHA-FC) and quality of life remain equivocal. The rece nt presentation of the results from several large-scale trials which were t erminated early because of significant survival benefit, has removed any co ncern over the robustness of the mortality data. Available evidence suggest s that a wide variety of patients with CHE including the elderly, should be considered for beta-blocker therapy. Caution is warranted in the initiatio n and titration of therapy, as symptoms of CHF may transiently worsen. Whet her all beta-blockers are equally efficacious remains unknown.