Summary of the recommendations for β blocker use in patients with heart failure adopted in Italy
| Which patients with congestive heart failure are suitable for β blocker treatment? |
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| • patients with dilated cardiomyopathy of any cause, with depressed left ventricular function (ejection fraction < 40%), in NYHA class II–III, clinically stable on angiotensin converting enzyme inhibitor, diuretic, and digitalis treatment |
| Which patients are more likely to benefit? |
| • NYHA class II−III |
| • history of hypertension |
| • heart rate > 90 beats/min |
| • symptom duration < 24 months |
| Which patients are less likely to benefit? |
| • advanced heart failure (high wedge pressure, hypotension, cardiac index < 2.5 l/min/m2) |
| • symptom duration > 24 months |
| • severe biventricular dysfunction |
| • systolic blood pressure < 100 mm Hg |
| • heart rate < 70 beats/min |
| For which patients do uncertainties still exist (scarce data from trials)? |
| • elderly patients (> 75 years) |
| • NYHA class IV |
| • comorbidities (diabetes, chronic obstructive pulmonary disease, renal failure, peripheral vasculopathy) |
| • asymptomatic left ventricular dysfunction |
| • heart failure caused by valvar disease or diastolic dysfunction |
| What are the contraindications? |
| • severe chronic obstructive pulmonary disease |
| • first degree AV block (PQ > 0.28 seconds) |
| • second degree AV block (Mobitz 2 or advanced) |
| • patients being treated with intravenous inotropes |
| • heart rate < 50 beats/min |
| • systolic blood pressure < 90 mm Hg |