Heart failure in the elderly: is beta-blockade the standard of care?

Heart failure is a significant problem among the elderly. Although many nonpharmacologic interventions, such as dietary sodium restriction, and drug therapy with digoxin and angiotensin-converting enzymes are considered to be the standard of care, ss-blockers have recently been shown to improve survival and reduce morbidity when added to the standard regimen. Although studies have demonstrated a significant benefit of ss-blockers, the drugs remain underutilized, partly from concerns about tolerability. Adapting a "start low, go slow" approach and titrating dosage upward can lessen tolerability issues and improve usage among the elderly.