PMID- 11144703
OWN - NLM
STAT- MEDLINE
DCOM- 20010308
LR  - 20181130
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 34
IP  - 12
DP  - 2000 Dec
TI  - Influence of beta-blockers on mortality in chronic heart failure.
PG  - 1440-51
AB  - OBJECTIVE: To briefly discuss the pathophysiology of heart failure and the 
      rationale for the use of beta-blockers in the treatment of chronic heart failure. 
      Key morbidity reduction trials are briefly mentioned, and recent mortality 
      reduction trials are reviewed. General recommendations regarding the use of 
      beta-blockers in heart failure are also included to guide clinical practice. 
      STUDY SELECTION/DATA EXTRACTION: Randomized, placebo-controlled clinical trials 
      and meta-analyses evaluating mortality reduction with beta-blockers in the 
      treatment of heart failure were identified using a MEDLINE search from January 
      1993 to March 2000. Abstracts and presented results from recent scientific 
      meetings were also considered. DATA SYNTHESIS: Beta-blockers have been shown to 
      decrease hospitalization for worsening heart failure, decrease the need for heart 
      transplant, improve New York Heart Association (NYHA) functional class, and 
      increase left-ventricular ejection fraction. A mortality benefit has recently 
      been demonstrated for patients with chronic heart failure. Carvedilol, 
      bisoprolol, and controlled-release/extended-release metoprolol decreased the risk 
      of dying by 65%, 34%, and 34%, respectively, in patients with primarily NYHA 
      functional class II or III and systolic dysfunction. The benefit of these agents 
      in patients with class IV heart failure or determining whether one agent has an 
      advantage over another is being investigated in ongoing clinical trials. 
      CONCLUSIONS: Several beta-blockers have demonstrated mortality reduction in the 
      treatment of patients with NYHA functional class II or III heart failure and 
      systolic dysfunction. Beta-blockers should be considered in these patients when 
      they are clinically stable and taking the current standard therapy of a diuretic 
      plus an angiotensin-converting enzyme inhibitor or other vasodilator agent.
FAU - Hart, S M
AU  - Hart SM
AD  - Anticoagulation Clinic, Henry Ford Health System, Henry Ford Medical 
      Center-Sterling Heights, MI 48310-5316, USA. shart3@hfhs.org
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - GEB06NHM23 (Metoprolol)
RN  - Y41JS2NL6U (Bisoprolol)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Bisoprolol/therapeutic use
MH  - Carbazoles/therapeutic use
MH  - Carvedilol
MH  - Chronic Disease
MH  - Heart Failure/*drug therapy/epidemiology/mortality
MH  - Humans
MH  - Metoprolol/therapeutic use
MH  - Morbidity
MH  - Propanolamines/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
EDAT- 2001/01/06 11:00
MHDA- 2001/03/10 10:01
CRDT- 2001/01/06 11:00
PHST- 2001/01/06 11:00 [pubmed]
PHST- 2001/03/10 10:01 [medline]
PHST- 2001/01/06 11:00 [entrez]
AID - 10.1345/aph.10037 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2000 Dec;34(12):1440-51. doi: 10.1345/aph.10037.