Effects of Beta-Blockers on Symptoms and Exercise Tolerance in Patients with Heart Failure

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A review of the effects of beta-blockade in patients with heart failure, including a pooled analysis of the overall effects on left ventricular ejection fraction.

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This study of beta-blockade in patients with purely idiopathic dilated cardiomyopathy showed symptomatic and exercise improvements, but no overall effect on total mortality. There was a reduction in a combined end-point of the need for transplantation and mortality.

Wisenbaugh T Katz I Davis J Essop R Skoularigius J Middlemost S Long-term (3 month) effects of a new beta-blocker (nebivolol) on cardiac performance in dilated cardiomyopathy. J Am Coll Cardiol 1993; 21: 1094–1100.

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CIBIS Investigators and Committees. A randomised trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994; 90: 1765–1773.

This is the largest, single randomised control trial to date of beta-blocker therapy in patients with heart failure. Heart failure was of mixed aetiology and there was no overall effect on total mortality.

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Australia New Zealand Heart Failure Research Collaborative Group. Effects of carvedilol in patients with congestive heart failure due to ischaemic heart disease: final results from the Australia-New Zealand Heart Failure Research Collaborative Group trial. Lancet 1997; 349: 375–380.

A study of beta-blocker therapy in patients with heart failure caused solely by ischaemic heart disease. This study showed improvement in left ventricular function, no change in symptoms and or exercise tolerance, and a reduction in a combined end-point of death or hospital admissions over 18 months.

Bristow MR Gilbert EM Abraham WT Adams KF Fowler MB Herschberger RG , for the MOCHA Investigators. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation 1996; 94: 2807–2816.

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This study from the SOLVD trial provided important data regarding neurohormonal activation in patients both with asymptomatic left ventricular dysfunction and clinical heart failure.

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This study reported the combined total mortality data from the four USA Carvedilol trials. Overall, there was a 65% reduction in total mortality. The results from these four trials and the ANZ carvedilol trial provided the basis for the approval of the USA Food and Drug Administration of the use of carvedilol in patients with heart failure.

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