Summary of the recommendations for β blocker use in patients with heart failure
| Indications | |
| Which patients with congestive heart failure are suitable for β blocker treatment? | |
| • Patients with symptomatic heart failure of any cause, with depressed left ventricular function (ejection fraction ⩽ 40%), in NYHA class II/III, clinically stable, already on treatment with ACE inhibitor, diuretic, and digitalis | |
| Which patients are more likely to benefit? | |
| • History of hypertension | |
| • Heart rate > 90 beats/min | |
| Which patients are less likely to benefit? | |
| • Severe biventricular dysfunction | |
| • Systolic blood pressure < 100 mm Hg | |
| • Heart rate < 60 beats/min | |
| Uncertain indications | |
| For which patients do uncertainties still exist (scarce data from trials)? | |
| • Elderly patients (> 75 years) | |
| • NYHA class IV | |
| • Asymptomatic left ventricular dysfunction | |
| • Heart failure caused by valvar disease or diastolic dysfunction | |
| • Comorbidities (diabetes, mild to moderate obstructive pulmonary disease, renal failure, peripheral vasculopathy) | |
| Contraindications | |
| What are the contraindications? | |
| • Severe chronic obstructive pulmonary disease | |
| • First degree AV block (PQ > 0.28 seconds) and second degree AV block (Mobitz 2 or advanced) | |
| • Heart rate < 50 beats/min | |
| • Systolic blood pressure < 90 mm Hg | |
AV, atrioventricular.