Beta-blockers in the treatment of chronic heart failure. Great therapeutic options,however, hitherto little applied

Overview

Beta-blockers are a marked improvement in the treatment of chronic heart failure as has beenconfirmed by a number of mortality studies. The favorable effect of beta-blockers on mortalityand morbidity has been found in patients already treated with ACE inhibitors and diuretics.Beta-blockers lower overall mortality by 36 % and markedly decrease even mortality due tosudden death. Beta-blockers on a long-term basis markedly improve the systolic function of theleft ventricle and return the remodelation of the left ventricle to normal. In their effect severalfactors are in play, among the most significant being the anti-arrhythmic and anti-ischemicinfluence of beta-blockers as well as the protection of the myocardium against catecholaminetoxicity. Cessation of treatment with beta-blockers leads to a deterioration of the patients'clinical state. Not all beta-blockers can be applied in therapy; only carvediolol, bisoprolol andretarded metoprolol succinate. Treatment begins with low doses which are gradually titered tohigher ones.The combination of beta-blocker therapy withACEinhibitors has the greatest effecton overall mortality, lowering it by 46 %.The treatment of chronic heart failure is by far not optimal neither in the Czech Republic norin Europe, and requires rapid improvement. As of now, clinical practice seriously lags behindscientific knowledge. It is surprising that in Europe therapy in hospitals is not better thantreatment at the general practitioners.Shortcomings in the pharmacotherapy of patients with chronic heart failure can in part beexplained by the fact that the revolutionary change in the role of beta-blockers from formerlycontraindicated to absolutely indicated has come about at the close of the 1990s, and most ofthe major studies have not been published until 1999. Thus, one can only hope that the situationshall improve in our country as well as in Europe.

Key words:
beta-blockers - heart failure - IMPROVEMENT of HF - EuroHeart Failure Survey- state of the treatment of heart failure - Europe - Czech Republic.