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Cardiology


Answer 5
  1. ß-Blocker therapy should not be initiated in patients with severe class IV CHF. Recent data from the Copernicus trial revealed a significant decrease in mortality with use of carvedilol in patients with class IV heart failure. Subgroup analysis of a much smaller population from the MERIT trial showed mortality benefit from metoprolol tartrate in this patient group. Since ß-blockers have different receptor affinities, they cannot be considered interchangeable as a pharmacologic class for the treatment of CHF.

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