Question: Which Beta blockers have been proven to work in treating heart failure?
Answer: So that's a very interesting question, and unlike ACE inhibitors there are some differences between different beta blockers when they have been tried in patients with heart failure. So there are three beta blockers -- carvedilol, long-acting metoprolol and bisoprilol -- that have all been shown to reduce all-cause mortality for patients with heart failure.
There are some other beta blockers that have been tried in patients with heart failure and did not improve outcomes like bucindilol or nebivolol, they did not reduce all-cause mortality.
So that makes it a little bit challenging, and I think most of the recommendations at this point would point out that perhaps we are to stick to the beta blockers that we know for a fact reduce mortality in patients with heart failure, which is as we discussed, carvedilol, long-acting metoprolol and bisoprilol.
Obviously, the beta blockers that we know for a fact they do not reduce mortality should not be given. But I think the bigger question that comes up is there are a lot of beta blockers out there that historically for a very long time we have been using in patient like atenolol, like short-acting metoprolol, and what to do with these medications in patients who have heart failure.
And I think my recommendation would be that in the absence of any data, I have no idea when we give patients with heart failure atenolol, whether it is going to act like carvedilol or metoprolol on one hand, or it's going to act like buindilol or nebivolol. And I think to give patients the benefit of the doubt, I think we probably ought to stick to the beta blockers we know for a fact improve outcomes in these patients.