Congestive heart failure beta blockers: Difference between revisions

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==Indications for Beta Blockers in CHF==
==Indications for Beta Blockers in CHF==
A patient should be administered a "heart failure approved" beta blocker if:
A patient should be administered a "heart failure approved" beta blocker (metoprolol succinate, carvedilol, bisoprilol) if:


1. [[Left Ventricular Ejection Fraction]] ([[LVEF]]) ≤ 40%
1. [[Left Ventricular Ejection Fraction]] ([[LVEF]]) ≤ 40%

Revision as of 00:14, 4 April 2012

Congestive Heart Failure Microchapters

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Initial and Serial Evaluation of the HF Patient
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Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School

Indications for Beta Blockers in CHF

A patient should be administered a "heart failure approved" beta blocker (metoprolol succinate, carvedilol, bisoprilol) if:

1. Left Ventricular Ejection Fraction (LVEF) ≤ 40%

or

2. History of myocardial infarction (MI)

Background

  • Blockade of compensatory sympathetic stimulation is associated with arrhythmic, ischemic, remodeling, and apoptotic benefits.
  • Used as monotherapy or combined with conventional heart failure management, beta-blockers reduce the combined risk of morbidity and mortality.
  • Beta blocker therapy is recommended for ANY patient with reduced left ventricular ejection fraction (≤ 40%) regardless of the etiology of left ventricular systolic dysfunction (ischemic or nonischemic) or presence/absence of symptoms. Patients with or without heart failure (in other words, even those with asymptomatic left ventricular systolic dysfunction) are included in this recommendation.
  • Beta blockers approved by the FDA for use in the treatment of heart failure are metoprolol succinate and carvedilol. In Europe, bisoprolol is also approved for use in heart failure. In addition, beta blocker therapy is indicated for patients with history of myocardial infarction whether or not left ventricular systolic dysfunction or heart failure is present.
  • Beta blocker therapy should be initiated at low dosage and gradually uptitrated, as tolerated, toward target dosages of 200 mg daily for metoprolol succinate and 25 mg twice daily for carvedilol, or to the maximum tolerated dosage.
  • Lopressor should be used instead of atenolol in the patient with CHF.