From Richard N. Fogoros, M.D.,
Your Guide to Heart Disease.
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For years, evidence has been accumulating that beta blockers are useful drugs in patients with heart failure due to dilated cardiomyopathy. (Click here for a review of cardiomyopathy and heart failure.) This information has been taken up only slowly by much of the medical profession, because doctors had been taught for generations that if one thing is true, it's that you don’t use beta blockers in patients with heart failure. Consequently, tens of thousands of patients with heart failure are being treated inappropriately.

If there was final nail in the coffin of the mistaken belief that beta blockers are bad for patients with heart failure, that nail came with the COPERNICUS trial. Approximately 2200 patients with severe heart failure were enrolled in this trial. They all received optimal medical therapy with ACE inhibitors, diuretics, and digitalis. They were then randomly assigned to receive either carvedilol or placebo. The resulting analysis showed a 35% improvement in survival among patients receiving carvedilol. The improvement in survival was even greater in patients with particularly severe heart failure.

Furthermore, patients receiving the beta blocker had no more side effects than those receiving the inactive placebo.

The results of the COPERNICUS trial are in line with other recent studies examining the use of beta blockers in patients with heart failure. Trials using bisoprolol and metoprolol showed similar results.

The "proof" in favor of using beta blockers in heart failure is about as strong as "proof" in medicine ever gets. And the compelling benefit is not “merely” some difficult-to-measure quality of life parameter (though beta blockers seem to improve these, too) – the compelling benefit is a significant improvement in survival.

The survival benefits are so striking that one would think doctors would be rushing to place all their heart failure patients on beta blockers as soon as possible. Unfortunately, this is not happening.

Indeed, doctors seem to be ignoring the evidence in droves. The fact is, despite the striking evidence to the contrary, the notion that beta blockers are beneficial in heart failure is just too radical for many doctors to accept without mulling it over for a few years. It appears that a minority of heart failure patients likely to be helped by beta blockers are actually receiving those drugs today.

What to do if you have heart failure

If you have heart failure, what you should not do is wait expectantly for your doctor’s delicate sensibilities to come around. Beta blockers are not the only new and strikingly effective therapy for heart failure that your doctor might be ignoring. This is no time for you to be polite. This is life and death.

You either ought to be placed on beta blockers now, or you ought to receive a cogent explanation as to why you – you in particular – should not receive them. (Not all heart failure patients can receive beta blockers. Those with significant asthma, for instance, or with very low blood pressure may not be able to tolerate the drugs.)

When you bring up the issue of beta blockers with your doctor, if he/she merely gives you a puzzled look, a vague answer, a statement to the effect that the data is still inconclusive, or to the effect that the beta blocker studies must be bogus because everyone knows beta blockers are dangerous in heart failure – if your questions generate any of these responses, it’s time to get yourself to another doctor. Who knows what other helpful new approaches he or she may be withholding from you?