PMID- 10908096
OWN - NLM
STAT- MEDLINE
DCOM- 20001121
LR  - 20211203
IS  - 1071-9164 (Print)
IS  - 1071-9164 (Linking)
VI  - 6
IP  - 2 Suppl 1
DP  - 2000 Jun
TI  - From clinical trials to clinical practice: what we know and do not know about 
      beta-blockers and the heart.
PG  - 34-9
AB  - In the early 1980s, several lines of evidence suggested the possibility that 
      decreasing adrenergic drive could be beneficial in patients with chronic heart 
      failure. Clinical trials conducted in the 1990s have unequivocally shown that 
      beta-blockade improves left-ventricular ejection fraction (LVEF) in the failing 
      heart. Beta-blockers represent the only medical treatment that has been shown to 
      reverse the pathological myocardial remodeling observed in patients with chronic 
      heart failure. Beta-blockers are now a mainstay of therapy for patients with New 
      York Heart Association (NYHA) class II and III heart disease; however, several 
      issues remain unresolved regarding beta-blocker treatment of heart failure, 
      including (1) the potential role of beta-blockers in asymptomatic (NYHA class I) 
      patients; (2) the potential role of beta-blockers in patients with severe (NYHA 
      class IV) heart failure; (3) the possibility of more rapid dose titration; and 
      (4) the influences of sex, age, and race. Further studies evaluating the efficacy 
      of beta-blockade in class I and class IV patients are forthcoming; the results of 
      these trials will help to determine the role of beta-blocker therapy in patients 
      at the extremes of heart failure (ie, asymptomatic patients and those with 
      advanced heart failure). This article discusses the issues that still remain 
      regarding the transitioning of beta-blockade from clinical trials to clinical 
      practice and indicates areas in which further research is warranted. Finally, 
      barriers to treatment are discussed as well as possible strategies for overcoming 
      these obstacles.
FAU - Feldman, A M
AU  - Feldman AM
AD  - Cardiovascular Institute of the University of Pittsburgh Medical Center Health 
      System, Pennsylvania 15213, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/pharmacology/*therapeutic use
MH  - Age Factors
MH  - Chronic Disease
MH  - Clinical Trials as Topic
MH  - Dose-Response Relationship, Drug
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Patient Selection
MH  - Racial Groups
MH  - Severity of Illness Index
MH  - Sex Factors
RF  - 16
EDAT- 2000/07/25 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/07/25 11:00
PHST- 2000/07/25 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/07/25 11:00 [entrez]
PST - ppublish
SO  - J Card Fail. 2000 Jun;6(2 Suppl 1):34-9.