The effect of β-blockers on morbidity and mortality associated with heart failure

Recent studies of beta-blockors for treatment of chronic heart failure have ushered in a new era in clinical management. The Metoprolol Controlled Release/Extended Release Randomized intervention Trial in Congestive Heart Failure (MERIT-HF) was the largest trial to date of beta-blocker therapy ill heart failure. Terminated prematurely because of an overwhelmingly beneficial effect favoring metoprolol. the MERIT-HF study showed a 34% reduction in all-cause mortality, a 41% reduction in the risk of sudden death, and a 49%; reduction in the risk of death from worsening heart failure. An updated analysis that included a longer follow-up showed no degradation of the benefits. Moreover, the follow-up analysis showed that the beneficial effects of metoprolol therapy extended across a wide range of patient subgroups and baseline clinical characteristics. More patients in the placebo group discontinued treatment for any reason and specifically for worsening heart failure. The results of the MERIT-HF: study confirmed and extended evidence that patients with stable class II or class III heart failure benefit from the addition of a beta-blocker to standard therapy.