Abstract
Large randomized clinical trials of bisoprolol, carvedilol and metoprolol have conclusively demonstrated the efficacy and confirmed safety of beta-blockers in patients with chronic heart failure. Recently, the beneficial effects of carvedilol in patients with heart failure soon after an acute myocardial infarction have also been shown. Despite this, beta-blockers remain under-prescribed in this condition. This is of particular importance as heart failure is common and increasing in prevalence. In this article, when to start beta-blockade and which beta-blocker to use is considered. Since carvedilol is the most studied beta-blocker in heart failure and has a broad range of activities that extend beyond beta-blockade, whether it has possible advantages over other beta-blockers is discussed. Also, how the use of beta-blockade might evolve with the introduction of device-related therapy in heart failure is considered.
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