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Beta blockers: are they difficult to use in heart failure patients?

In the United States it is estimated that 4.8 million Americans have heart failure. Heart failure occurs in 1.5% of all adults and between 6 and 10% of adults over the age of 65. It is estimated that there are from 400,000 to 700,000 new cases per year, resulting in more than 800,000 hospitalizations. Heart failure is the most frequent cause of hospitalization in elderly patients and it accounts for 5 to 10% of all hospital admissions. Heart failure results in or contributes to approximately 250,000 deaths per year. Since 1970, the incidence of heart failure in the United States has increased steadily. Most patients have ischemic heart disease as the etiology, and this is reflected in all clinical trials of heart failure. It has been estimated that the total cost of care for heart failure patients is 38 billion dollars, equivalent to 5.4 % of the total health care cost in the U.S. Since 1955, mortality due to heart failure has steadily risen from about 50,000 per year to slightly fewer than 300,000 per yearin 1991. The published randomized clinical trials of heart failure patients (CONSENSUS, PROMISE, PRAISE, V-HEIT, DIG, SOLVD, and SOLVD-PREVENTION) clearly show a high mortality over a period of 4 to 5 years in patients treated with digitalis, diuretics, and an angiotensin-converting enzyme (ACE) inhibitor. In fact, the lowest mortality rate was approximately 30% at 4 years in the SOLVD treatment trial. Thus, despite the fact that ACE inhibitors have decreased mortality compared with therapy with digoxin and diuretics alone, mortality is still unacceptably high.