Beta Blocker Use in Heart Failure

Indications and Benefits

• The American College of Cardiology recommends beta blockers for all patients with left ventricular ejection fraction (LVEF) ≤40% with heart failure or prior myocardial infarction, unless contraindicated, as they are strongly recommended (Class I recommendation) 1
• Specific beta blockers, including carvedilol, metoprolol succinate, and bisoprolol, have been shown to have a mortality benefit in patients with heart failure 1, 3
• The European Society of Cardiology suggests that beta blockers should be used in combination with ACE inhibitors and aldosterone antagonists in patients with LVEF <40% to reduce mortality and hospitalization 4, 3

Contraindications and Cautions

• The American Heart Association indicates that beta blockers are not contraindicated based on LVEF alone, but should be used with caution in patients with cardiogenic shock 5
• The American Heart Association also recommends caution when using beta blockers in patients with severe bradycardia or heart block without pacemaker 5