Initiation and use of beta-blockers in class IV heart failure.

Treatment of patients with heart failure caused by left ventricular systolic dysfunction using b-adrenergic receptor antagonists (or b-blockers) results in improvements in symptoms, hemodynamics, left ventricular remodeling, morbidity, and mortality. Most patients studied in prospective, randomized placebo-controlled trials have had New York Heart Association (NYHA) functional class II or III symptoms. The efficacy of b-blockers in treating NYHA class IV patients is not as well-established. This review summarizes the published experience regarding the use of b-blockers in patients with advanced heart failure. Although treatment requires considerable care, the data support attempts at initiation of b-blockers in this group of patients.