HFrEF pharmacological treatment: beta blockers

By incremental steps over several decades of research, beta blockers have evolved ‘from bench to bedside’, emerging as a keystone of modern optimal pharmacotherapy for heart failure. This chapter starts by detailing the story of their development, focusing on the randomized trials that established their clinical efficacy in reducing hospitalization and death. Subsequently, issues such as the potential heterogeneity among different beta-blocker agents and the appropriate dose targets in heart failure are discussed. Advice regarding the initiation, titration, and discontinuation of beta blockers is presented, providing practical guidance for healthcare professionals who manage patients with heart failure. Finally, the chapter explores the evidence underlying the use of beta blockers in specific populations, such as elderly patients, black patients, and those with atrial fibrillation, obstructive airways disease, or asymptomatic left ventricular systolic dysfunction.