Intended for healthcare professionals

Letters β blockers for heart failure

Authors’ reply to Cunningham and Messerli and colleagues

BMJ 2016; 353 doi: (Published 07 June 2016) Cite this as: BMJ 2016;353:i3141
  1. Dipak Kotecha, clinician scientist in cardiovascular medicine1,
  2. Douglas G Altman, professor of statistics in medicine2,
  3. Peter D Collins, professor of cardiology3,
  4. Marcus D Flather, professor of medicine and clinical trials4
  1. 1Institute of Cardiovascular Science, Medical School, University of Birmingham, Birmingham B15 2TT, UK
  2. 2Centre for Statistics in Medicine, University of Oxford, Oxford, UK
  3. 3National Heart and Lung Institute, Imperial College, London, UK
  4. 4Norwich Medical School, University of East Anglia, Norwich, UK
  1. d.kotecha{at}

Cunningham raises two important points about bias and external validity.1 2 We agree that the age of patients in trials does not reflect that of patients with heart failure in the community, and comment on this point in our discussion. To improve the applicability of future research, we must as researchers enrol patients who reflect the true population. Just as importantly, as clinicians we need to temper our preconceptions about treatment efficacy versus tolerability with the knowledge that in double blinded trials, β blockers are highly effective and well tolerated. In this context, it is wrong to equate these data with …

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