Table 1.

Summary of the recommendations for β blocker use in patients with heart failure at the start of the study (1998)

Indications

Patients with symptomatic heart failure from any cause, with depressed left ventricular function (ejection fraction ≤40%), in NYHA class II–III, clinically stable, already on treatment with ACE inhibitor, diuretic, and digitalis

Patients more likely to benefit are those with:

• History of hypertension

• Heart rate >90 beats/min

Patients less likely to benefit are those with:

• Severe biventricular dysfunction

• Systolic blood pressure <100 mm Hg

• Heart rate <60 beats/min

Uncertain indications

Elderly patients (>75 years)

NYHA class IV

Asymptomatic left ventricular dysfunction

Heart failure caused by valvar disease or diastolic dysfunction

Comorbidities (diabetes, mild to moderate obstructive pulmonary disease, renal failure, peripheral vascular disease)

Contraindications

Severe chronic obstructive pulmonary disease

First degree AV block (PQ >0.28 seconds) and second degree AV block (Mobitz 2 or advanced)

Heart rate <50 beats/min

Systolic blood pressure <90 mm Hg

ACE, angiotensin converting enzyme; AV, atrioventricular; NYHA, New York Heart Association.