Issue 142 Item 9 Huge Mistake – Heart Failure Patients Not Being Treated With Be

This is a HUGE problem…and often a HUGE mistake because Beta-blockers increase survival by about 35%. Millions of patients are hospitalized for heart failure every year. Most of them don’t get a beta-blocker…due to concerns that it could worsen cardiac output. This is a HUGE problem…and often a HUGE mistake. Beta-blockers increase survival by about 35%.

Most heart failure patients should get a beta-blocker…but ONLY after they’re stabilized on a diuretic, ACE inhibitor, etc. Suggest metoprolol or carvedilol…they’re the only beta-blockers approved for heart failure.

Metoprolol extended-release (Toprol XL) selectively blocks the beta-1 receptor. It’s often preferred for patients who have LOW blood pressure or pulmonary disease. It lowers blood pressure less than carvedilol…and is less likely to exacerbate pulmonary conditions.

Carvedilol (Coreg) blocks beta-1, beta-2, and alpha-1 receptors. It’s often preferred for patients with HIGH blood pressure. Keep in mind that beta-blockers can worsen symptoms initially. To minimize this, patients start on low doses…and increase slowly. Takes 2 to 3 months to see improvement.

Even if symptoms don’t improve, encourage patients to continue using a beta-blocker to prevent cardiac deterioration

Pharmacotherapy 2002;22:1036. Am J Health-Sys Pharm 2002;1340. Ann Pharmacother 2003;37:287. Am J Med 2002;112:49. Am J Med 2000;109:523. Lancet 2002;360:1375. New Engl J Med 2002;347;1909,1962. BMJ 2002;325:1333. Mayo Clin Proc 2002;77:1199,1206. JAMA 2002;287:890