Author + information
- Received February 10, 2019
- Revision received April 2, 2019
- Accepted April 3, 2019
- Published online July 29, 2019.
- Philip Joseph, MDa,∗ (, )
- Karl Swedberg, MD, PhDb,c,
- Darryl P. Leong, MBBS, PhDa and
- Salim Yusuf, DPhila
- aPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- bDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- cNational Heart and Lung Institute, Imperial College, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Philip Joseph, Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.
• This review examines the current evidence for β-blockers in heart failure and CAD.
• Current evidence strongly supports the use of β-blockers in HFrEF.
• Contemporary clinical trials are needed for HFpEF, HFmEF, acute coronary syndrome, and stable CAD.
As new treatments continue to improve clinical outcomes in coronary artery disease (CAD) and heart failure, it is necessary to characterize the appropriate use of β-adrenergic receptor blockers (β-blockers) in the contemporary management of these conditions. This review examines the current evidence supporting β-blocker use in heart failure with preserved ejection fraction (HFpEF), heart failure with midrange ejection fraction (HFmEF), and heart failure with reduced ejection fraction (HFrEF), following acute coronary syndrome and in stable CAD. β-Blockers remain essential in the treatment of HFrEF, but limited evidence supports their use in HFmEF or HFpEF. They should still be considered routinely following acute coronary syndrome, but there is a need for contemporary trials that re-examine this in patients without left ventricular dysfunction, as well as in patients with stable CAD. From a global perspective, more studies are needed to characterize the extent of β-blocker use in CAD and heart failure, and how evidence-based use can be improved in these conditions.
Drs. Joseph, Leong, and Yusuf note their institutions have received research support from granting agencies and pharmaceutical companies for polypill/combination therapy projects. Dr. Swedburg has been a consultant for and has received honoraria from AstraZeneca, Novartis, Pfizer, Servier, and Vifor Pharma. Dr. Leong is supported by the Heart and Stroke Foundation of Canada. Dr. Yusuf is supported by the Marion Burke Chair of the Heart and Stroke Foundation of Canada.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received February 10, 2019.
- Revision received April 2, 2019.
- Accepted April 3, 2019.
- 2019 American College of Cardiology Foundation
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