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The Evolution of β-Blockers in Coronary Artery Disease and Heart Failure (Part 1/5)

Philip Joseph1, Karl Swedberg2, Darryl P Leong1

  • 1Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.

Journal of the American College of Cardiology
|August 3, 2019
PubMed

Insights

Beta-blockers are crucial for heart failure with reduced ejection fraction (HFrEF) but lack strong evidence for other heart failure types. Further research is needed to optimize their use in coronary artery disease and heart failure globally.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Advancements in treatments for coronary artery disease (CAD) and heart failure necessitate updated guidelines for beta-adrenergic receptor blocker (β-blocker) use.
  • Understanding the current role of β-blockers across different heart failure classifications and CAD scenarios is essential for evidence-based practice.

Purpose of the Study:

  • To review and characterize the appropriate use of β-blockers in contemporary management of heart failure (HF) and coronary artery disease (CAD).
  • To examine evidence for β-blocker efficacy in heart failure with preserved ejection fraction (HFpEF), midrange ejection fraction (HFmEF), and reduced ejection fraction (HFrEF), post-acute coronary syndrome, and in stable CAD.

Main Methods:

  • Systematic review of current evidence.
  • Analysis of β-blocker utilization in various clinical contexts of heart failure and coronary artery disease.

Main Results:

  • β-Blockers are essential for treating HFrEF.
  • Limited evidence supports β-blocker use in HFmEF and HFpEF.
  • Routine consideration of β-blockers post-acute coronary syndrome is recommended, but re-evaluation is needed for patients without left ventricular dysfunction and in stable CAD.

Conclusions:

  • β-Blocker efficacy is well-established in HFrEF, but requires further investigation in other HF subtypes and stable CAD.
  • Contemporary trials are needed to re-examine β-blocker use in specific patient populations within CAD and heart failure.
  • Global studies are required to assess current β-blocker usage patterns and identify areas for improvement in evidence-based application.

Keywords:
beta-blockerscoronary artery diseaseheart failure

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