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Consider β blockers for patients with heart failure

BMJ 2009; 338 doi: (Published 01 June 2009) Cite this as: BMJ 2009;338:b1728
  1. Henry Krum
  1. 1Centre of Cardiovascular Research & Education in Therapeutics, Dept of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne 3004, Australia
  1. Correspondence to: H Krum henry.krum{at}
  • Accepted 22 December 2008

β blockers remain underused in chronic heart failure despite important benefits, but the difficulty in starting treatment is probably overestimated

Key points

  • β blockers are essential therapy in systolic chronic heart failure, with important mortality benefits, but they remain underused because of concerns about difficulties in starting treatment

  • Recent evidence suggests that despite these concerns all practitioners, including non-cardiologists, should consider patients with heart failure for β blockers; even elderly patients and those with relative contraindications tolerate the drugs well

  • β blockers should be started at low doses in selected patients and titrated up slowly to target dose if possible, with monitoring throughout this process

The clinical problem

Chronic systolic heart failure is a major public health problem that is associated with high mortality, poor quality of life, and frequent hospitalisation.1 The sympathetic nervous system is a key activated neurohormonal system that drives progression of this disorder; blocking this system with β adrenergic blocking drugs can improve clinical outcomes.2 However, the underuse of β blockers is well documented,3 4 whether by cardiologists or by other specialists, such as geriatricians, general physicians, and general practitioners, who manage many, if not most, patients …

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