Beta-blocker therapy in heart failure: myths or realities

The cumulative evidence acquired over 20 years suggests that beta-blockers improve functional capacity, ventricular function, and decrease mortality in patients with heart failure either due to dilated cardiomyopathy or ischaemic heart disease. This effect is independent of the beneficial effects of digoxin, diuretics and particularly ACE inhibitors and has resulted in re-evaluation of requirements for transplantation in patients with advanced cardiac failure. Ninety percent of patients appear to respond to beta-blockers but no clinical or biochemical parameters can identify a favourable response. The beneficial effects occur slowly but last for years. Further ongoing trials will provide more information but beta-blockade therapy should be considered in addition to other therapy in the management of heart failure.