Beta-blocking in heart failure patients: Balancing the evidence

Evidence for the effectiveness of beta-blockers in the management of patients with heart failure is now compelling with a database of over 13 000 patients enrolled in randomised prospective placebo-controlled clinical trials. However this therapy remains vastly underused in clinical practice. The different points challenging the widespread use beta blockade agents in the routine treatment in heart failure are presented and discussed. After a review of the potential mechanism hypothesised behind the benefits of beta-blockers in heart failure, the controversial effects on the haemodynamics, exercise tolerance, hospitalisation and mortality are underlined.