This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Beta blockers in cardiac failure

Authoring team

  • there is evidence that beta-blockers can improve prognosis in patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (1,2)

  • offer both angiotensin-converting enzyme (ACE) inhibitors and beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction. Use clinical judgement when deciding which drug to start first (3)

  • offer beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction, including (3):
    • older adults and
    • patients with:
      • peripheral vascular disease
      • erectile dysfunction
      • diabetes mellitus
      • interstitial pulmonary disease and
      • chronic obstructive pulmonary disease (COPD) without reversibility

  • introduce beta-blockers in a 'start low, go slow' manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta-blocker (3)

    • beta-blocker therapy should be started at a very low dose (e.g. carvedilol 3.125mg once daily) and titrated slowly over a period of weeks or months
      • the beta-blocker should be up-titrated at fortnightly intervals (or longer in more sensitive patients) to a target dose of carvedilol 25-50mg bd or bisoprolol 10mg od (2,4)

  • switch stable patients who are already taking a beta-blocker for a comorbidity (for example, angina or hypertension), and who develop heart failure due to left ventricular systolic dysfunction, to a beta-blocker licensed for heart failure
  • there may be some early symptomatic deterioration during beta-blocker therapy (4)
  • beta-blockers do not provide an instant beneficial effect in CHF
    • initially patients may feel more tired and they may experience symptoms of worsening fluid retention requiring a temporary increase in diuretic therapy
    • beneficial effects on LV function can take 3 to 6 months to appear

Notes:

  • there is evidence that carvedilol reduced the risk of all cause mortality and combined mortality and general and specific hospital admission in severe heart failure (5) - these results were regardless of pretreatment systolic blood pressure
  • use of beta-blockers in in patients >/=70 years, regardless of ejection fraction. There is evidence that, in this patient population, nebivolol, a beta-blocker with vasodilating properties, is an effective and well-tolerated treatment for heart failure in the elderly (6)
  • the magnitude of the prognostic benefit conferred by beta-blockers in the absence of ACE-I appears to be similar to those of ACE-Is in systolic CHF (7)
  • a meta-analysis has shown that beta-blockers appear to effectively reduce the occurrence of AF in patients with systolic HF (8)
  • heart rate reduction and beta blockers in heart failure
    • a meta-analysis (9) found that the extent of heart rate reduction in patients with chronic heart failure treated with beta-blockers was significantly associated with survival benefit in trials, whereas the dose of beta-blocker was not
      • for every 5 beats/minute reduction in heart rate using beta-blocker treatment, the relative risk of death was decreased by 18%, although the heart rate reduction at which this benefit stops is not known

Reference:


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.