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.
