Although the negative inotropic effect of beta-blockers was initially
considered a risk in heart failure, these drugs actually improve ejection
fraction in CHF. Although short-term deterioration may occur, continued
therapy improves symptoms. Catecholamines cause vasoconstriction,
increase metabolic demands, decrease diastolic filling, reduce coronary
flow, and affect left ventricular remodeling; therefore, blocking
chronic adrenergic stimulation is beneficial. The use of beta-blockers
such as carvedilol and metoprolol results in improved ejection fraction
(noticeable within a few months), fewer hospitalizations, and improved
- Long-term use of beta-blockers risks worsening of CHF.
1. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Am J Cardiol 1999;83:1A-38A.
2. Gomberg-Maitland M, Baran DA, Fuster V. Treatment of congestive heart failure:
guidelines for the primary care physician and the heart failure specialist.
Arch Intern Med 2001;161:342-52.
3. Heart failure. In: Arky RA, Kettyle WM, Hatem CJ, editors. MKSAP 12:
Cardiovascular medicine. Philadelphia: American College of Physicians - American
Society of Internal Medicine; 2001:38-49.
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