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Oscar M. P. Jolobe, MRCP(UK), DPhil

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The results of the study showing significantly more readmissions for heart failure in patients treated with evidence-based β-blockers than in their β-blocker naïve counterparts¹ need to be interpreted in the light of eligibility criteria for this treatment modality. In one study, in which carvedilol generated a significant survival benefit and a significant reduction in the combined risk of death or hospitalization, eligible patients were those with left ventricular systolic dysfunction who, despite "dyspnoea or fatigue at rest or on minimal exertion," were, nevertheless, clinically euvolaemic.² Conversely, in an earlier study, patients with heart failure (left ventricular systolic function and blood volume status undefined) in whom the β-blocker challenge had failed with a worsening of heart failure were characterized by New York Heart Association (NYHA) functional class III and IV, and those with conditions that did not deteriorate with the challenge were either in functional . . . [Full Text of this Article]

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