Clinical trials of β-blockers in heart failure: a class review

Heart failure remains a clinically challenging illness, with increasing incidence and prevalence and a high risk of mortality. The introduction of agents that interfere with the neurohormonal response to chronic left-ventricular dysfunction has resulted in improved patient outcomes. Owing to slowed disease progression and reduced mortality, angiotensin-converting enzyme (ACE) inhibitors are indicated in all patients with heart failure. New data indicate that in appropriate patients, β-blocker therapy relieves the symptoms associated with heart failure, reduces hospitalizations, and improves survival when added to standard therapy. Questions still remain regarding the ideal use of β blockers in heart failure, and ongoing trials will attempt to clarify those points.