Congestive heart failure beta blockers

Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School;

Indications for Beta Blockers in CHF
A patient should be administered a "heart failure approved" beta blocker (metoprolol succinate, carvedilol, bisoprilol) if:

1. The Left Ventricular Ejection Fraction (LVEF) is ≤ 40%

or

2. There is a history of myocardial infarction (MI)

Background
(CHF).
 * Blockade of compensatory sympathetic stimulation is associated with arrhythmic, ischemic, remodeling, and apoptotic benefits.
 * Used as monotherapy or combined with conventional heart failure management, beta blockers reduce the combined risk of morbidity and mortality.
 * Beta blocker therapy is recommended for ANY patient with reduced left ventricular ejection fraction (≤ 40%) regardless of the etiology of left ventricular systolic dysfunction (ischemic or nonischemic) or presence/absence of symptoms. Patients with or without heart failure (in other words, even those with asymptomatic left ventricular systolic dysfunction) are included in this recommendation.
 * Beta blockers approved by the FDA for use in the treatment of heart failure are metoprolol succinate and carvedilol. In Europe, bisoprolol is also approved for use in heart failure. In addition, beta blocker therapy is indicated for patients with history of myocardial infarction whether or not left ventricular systolic dysfunction or heart failure is present.
 * Beta blocker therapy should be initiated at low dosage and gradually uptitrated, as tolerated, toward target dosages of 200 mg daily for metoprolol succinate and 25 mg twice daily for carvedilol, or to the maximum tolerated dosage.
 * Lopressor should be used instead of atenolol in the patient with congestive heart failure

==ACC/AHA Guidelines- Beta Blocker Recommendation == {{cquote|

Class I
1. Beta blockers (using 1 of the 3 proven to reduce mortality, i.e., bisoprolol, carvedilol, and sustained release metoprolol succinate) are recommended for all stable patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF), unless contraindicated. (Level of Evidence: A)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult


 * 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation