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Q J Med 1999; 92: 673-678
© 1999 Association of Physicians

Commentary papers

Beta-blockers for heart failure–time to think the unthinkable?

C.H. Davies and Y. Bashir

From the Departments of Cardiovascular Medicine and Cardiology, John Radcliffe Hospital, Oxford, UK

Dr C.H. Davies, Department of Cardiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201-3098, USA

Introduction

Heart failure accounts for 5% of acute medical admissions in the UK and its incidence is rising as the population ages.1 The natural history is characterized by inexorable progression, with a steady attrition of patients from terminal pump failure or sudden death. Despite wider and earlier use of angiotensin-converting-enzyme (ACE) inhibitors, the outlook remains poor, with 40–50% mortality within 5 years among patients suffering from mild-to-moderate heart failure, rising to 70–80% in more advanced heart failure.2 The notion that ß-blockers may confer substantial prognostic benefits in chronic heart failure will seem counterintuitive and even inconceivable to generations of clinicians brought up with the strict doctrine that these agents are harmful to patients with impaired ventricular function. Nevertheless, a compelling weight of evidence now supports such a radical and unprecedented U-turn in clinical practice. This evidence has emerged in three distinct phases: early reports and hypothesis-generating studies, followed by medium-sized . . . [Full Text of this Article]

Hypothesis-generating studies

Potential mechanisms of action—changing paradigms in heart failure

Haemodynamic mechanisms
Cellular mechanisms
Electrical mechanisms
Peripheral mechanisms

Medium-sized randomized trials

Mortality trials

Practical implications for heart failure therapy

References


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