Beta-blockers for heart failure: where are we now?

The hypothesis that the long-term use of beta-blockers improves symptoms, cardiac function, and ejection fraction in patients with heart failure is increasingly being accepted. Multiple small studies have consistently demonstrated favorable outcomes with beta-blocker use, and a large-scale mortality study is now planned. However, important questions remain regarding which patients with heart failure should be treated and the mechanism by which beta-blockade exerts its beneficial effects. These questions undoubtedly need to be answered before physicians will be willing to prescribe these medications, the use of which is so counterintuitive.