In-hospital initiation of beta-blocker therapy for heart failure

Neurohumoral antagonism is the cornerstone of heart failure management. Because of their beneficial effects on disease progression, functional status, hospitalizations, and mortality risk, ACE inhibitors and beta blockers should be prescribed for all patients with left ventricular systolic dysfunction unless specific well defined contraindications exist. Beta blockers have unequivocally been demonstrated to improve survival (35% mortality reduction) in patients with Class I-IV heart failure due to systolic dysfunction. Additional benefits include reduced hospitalization, myocardial infarction, and sudden death. Beta blockers are also beneficial in patients with asymptomatic left ventricular dysfunction (LVEF < 0.45), myocardial infarction, hypertension, coronary artery disease, cerebral vascular disease, peripheral vascular disease, and diabetes. Patients with diastolic dysfunction heart failure also likely benefit from beta blocker therapy, but this has not been tested in prospective randomized clinical trials.