Beta-adrenergic blocker mortality trials in congestive heart failure

Many of the current discussions of beta-adrenergic blocker therapy in patients with congestive heart failure have used fairy tales to describe the evolution of this treatment from contraindication to standard of care. This article reviews the early studies that initiated this revolution in heart failure therapy and discusses the major mortality trials that have demonstrated that these agents improve survival and limit the progression of congestive heart failure. These major trials have used 1 of 4 beta blockers (metoprolol, bisoprolol, carvedilol, or bucindolol) in varying study designs with different patient populations. Each trial had different objectives and limitations, and these are described in the context of their impact on proving a survival benefit. In addition, the specific effect of beta-blocker therapy on sudden death in patients with heart failure is briefly discussed. The weight of these trials suggests that beta-adrenergic blocker therapy can save 1 life of every 35 patients treated in patients with mild-to-moderate heart failure. The data are compelling and the techniques for "starting low and going slow" with titrations have been well documented.