Beta-blocker therapy among patients with heart failure

Beta-blocker therapy (or β-blocker therapy) has been proven to improve survival among patients with heart failure with reduced ejection fraction (HFrEF). There is a scarcity of evidence about the efficacy of β-blockers among patients with HFrEF and pacemaker devices. It seems that β-blocker is the main strategy for the management of patients with HFrEF because of their ability to reverse the neurohumoral dysfunction of the sympathetic nervous system. Since neurohumoral dysfunction is the main mechanism of HF progression, β-blockers may have prognostic and symptomatic benefits. Despite proven benefits, β-blockers are underused because of the wrong belief that bradycardia and hypotension can worsen the hemodynamics status of patients with HFrEF. The comorbidities are considered an absolute contraindication to the use of β-blockers due to false belief. This chapter on β-blockers includes the clinical pharmacology and evidence of the cardioprotective effects of these drugs in patients with HFrEF to promote their use. The current guidelines for the use of β-blockers in clinical practice in HF in the presence of comorbidities such as pulmonary disease, diabetes, atrial fibrillation, and peripheral arterial disease are also emphasized. It seems that this discussion may allow for a proper diffusion of knowledge about the correct use of β-blockers and the drug–disease interactions to achieve their increased use and titration. The selection of a specific β-blocker with a view to a properly tailored approach for HFrEF patients is also emphasized. © 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.