Benefits of inpatient initiation of β-blockers

Clinical trials have demonstrated that β-blockers effectively reduce mortality in patients after a myocardial infarction (MI) and in patients with chronic heart failure. Treatment guidelines recommend that all patients after MI without a contraindication receive early β-blocker treatment. Initiation of β-blockers also should be considered for stable patients who are hospitalized with heart failure. Despite well-documented benefits, however, β-blockers are still underused. Barriers that cause reluctance by physicians to initiate therapy include the traditional belief that β-blockers are contraindicated in patients with left ventricular dysfunction, complexity of management, perceived risk of adverse events, and potential for short-term clinical deterioration. Intervention programs promoting β-blockers for inpatients have increased their use at discharge and after long-term follow-up. Because of pharmacologic differences, agent selection is also critical. Agents must have proven clinical efficacy, an established dose-titration regimen, and desirable pharmacokinetic properties. Increasing the use of these life-saving agents has the potential for substantial clinical impact.