Additional benefits versus practicalities of beta-blocker use in CHF patients: the ‘some is better than none’ rule

Treatments for heart failure include digoxin, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists and beta blockers. Beta blockers have been contra-indicated until fairly recently, with recognition of the role of the sympathetic nervous system in chronic progression of heart damage.
Benefits of beta blockade, proven in clinical trials, include reduction in all-cause mortality, sudden death, hospitalisation rates for heart failure, and reversal of some degree of heart damage. Carvedilol and bisoprolol are currently licensed in the UK for chronic heart failure. National Institute for Clinical Excellence (NICE) guidelines give recommendations for initiation of treatment, dose titration and management of adverse effects. Benefits are still apparent in patients who cannot tolerate target drug doses. Several studies show, however, that beta blockers are underprescribed in general practice.