Heart failure management with β-blockers: can we do better?

Area of Science:

• Cardiology
• Pharmacology

Background:

• Heart failure (HF) involves sympathetic nervous system overactivation, driving adverse cardiac remodeling and poor prognosis.
• Current HF management emphasizes symptom control and comorbidities over solely ejection fraction (LVEF).

Purpose of the Study:

• To review the role and efficacy of beta-blockers in managing heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
• To highlight the importance of beta-blocker titration for optimal patient outcomes.

Main Methods:

• Review of existing randomized, placebo-controlled trials and expert opinion on beta-blocker therapy in HF.
• Analysis of beta-blocker effects on symptoms, survival, hospitalization, and specific patient populations.

Main Results:

• Beta-blockers improve HF symptoms, functional status, survival, and reduce heart failure hospitalizations in HFrEF.
• In HFpEF, beta-blockers offer anti-ischemic and heart rate-lowering effects, and reduce mortality in patients with comorbidities like diabetes, CKD, and COPD.
• Higher beta-blocker doses correlate with improved clinical outcomes.

Conclusions:

• Beta-blockers are foundational therapy for HFrEF and beneficial in HFpEF, particularly with comorbidities.
• Adequate dose titration of beta-blockers is essential for maximizing patient benefit in heart failure management.
• Combination therapy including beta-blockers, RAAS inhibitors/neprilysin inhibitors, MRAs, and SGLT2 inhibitors may be considered.