Switching beta-blocker therapy in chronic heart failure

Background A beneficial effect on survival has been proven for the four long-acting beta-blockers. Such favorable results could not be obtained with short-acting beta-blockers. Aims: to study the safety of switching from short-acting metoprolol to long-acting bisoprolol in patients with cardiac failure and postinfarction impaired left ventricular systolic function. Methods and results 282 patients with NYHA classes I–III heart failure and/or postinfarction reduced left ventricular ejection fraction were enrolled in the study. Metoprolol tartarate was discontinued 12 h before the initiation of bisoprolol therapy. Dosages were as follows: 28.5% of the patients reached the 10 mg target dose, 21.5% received 7.5 mg, and 42.5% received 5 mg, while 7.5% stayed on the lowest 2.5 mg initial dose. Mean heart rate was 84 bpm before the switch; this dropped to 67 bpm with the above doses. Conclusion The switch from non-recommended short-acting beta-blockers to long-acting beta-blockers may be carried out safely in stable heart failure patients. The significant reduction of the heart rate indicated that a more effective adrenergic blockage might be obtained with the switch, although physicians could titrate up to the target dose only in about one-third of the cases.