Jeffrey S. Borer, MD, of the Howard Gilman Institute for Heart Valve Disease, discusses treating patients with heart failure with beta-blockers and whether there are any patients in this group who are not good candidates for this treatment.
Dr. Borer notes that current thinking holds that every patient with heart failure should be treated with beta blockers. However, he notes that not every patient can be treated with these drugs, as many patients cannot tolerate their side effects and experience adverse reactions.
There are several relative contraindications for treatment with beta blockers, including diabetes, lung disease, and peripheral vascular disease. Although these patients may not tolerate the drugs, that doesn’t mean that clinicians should not try them, notes Dr. Borer.
The major issue with using beta blockers to treat heart failure is that the current guidelines for the amount of a given beta blocker that should be given to a patient with heart failure are out of date “and not terribly useful,” according to Dr. Borer. The problem is not whether patients should be given these drugs, it’s whether they can tolerate them at the doses recommended in the guidelines.
There are several reasons for this discrepancy, including the fact that many of the trials were performed a long time ago, and since then “there have been important changes and additions to the armamentarium for treatment of patients with heart failure, which makes it difficult to give beta blockers in the relatively high doses that were suggested in the initial trials. Even in the seminal trials, not everyone received the doses of beta blockers that were recommended because they couldn’t tolerate them,” says Dr. Borer.