Beta-Blocker Therapy in Heart Failure Management

Beta-blockers antagonise sympathetic overstimulation and form a cornerstone of modern heart failure care by reducing heart rate, myocardial oxygen demand and neurohormonal activation. In heart failure with reduced ejection fraction (HFrEF), they improve survival, lower hospitalisation rates and facilitate reverse remodelling when titrated to guideline-recommended targets. Their role in heart failure with preserved ejection fraction (HFpEF) is more nuanced, with variable response across patient subgroups. Advances in pharmacogenomics and agent-specific profiles have informed personalised selection among bisoprolol, metoprolol, carvedilol and nebivolol. Implementation science has highlighted persistent gaps in dosing and uptake, particularly in resource-limited settings, underscoring the need for quality improvement. Ongoing research integrates mechanistic insights, comparative effectiveness and precision medicine to refine dosing strategies, optimise patient selection and expand global access to evidence-based therapy.

Research from Nature Portfolio

Recent studies have revealed that in patients with HFpEF without prior myocardial infarction, beta-blocker therapy was linked to an increased incidence of cardiovascular events and hospitalisations, suggesting the necessity for stratified risk–benefit assessment. Concurrently, observational work in chronic HFrEF cohorts demonstrated that although two-thirds of patients receive beta-blockers, only a minority are prescribed guideline-recommended agents at target doses. This underdosing is associated with higher rates of rehospitalisation and emphasises the critical importance of implementation efforts to achieve optimal utilisation and improve outcomes worldwide.

Beta-Blocker Therapy in Heart Failure Management publication trend

The graph below shows the total number of articles in beta-blocker therapy in heart failure management across all publications each year (not limited to Nature Index journals).

Technical terms

Beta-blockers: A class of medications that block β-adrenergic receptors, reducing heart rate, contractility and neurohormonal activation.

Ejection fraction: The percentage of blood ejected from the left ventricle during each contraction, used to categorise systolic function.

HFrEF (Heart failure with reduced ejection fraction): A form of heart failure defined by an ejection fraction typically below 40%, with impaired systolic performance.

HFpEF (Heart failure with preserved ejection fraction): A subtype of heart failure in which the ejection fraction is generally 50% or higher, often associated with diastolic dysfunction.

Sinus rhythm: The normal, regular rhythm of the heart initiated by electrical impulses from the sinoatrial node.

Atrial fibrillation: A common arrhythmia characterised by rapid, irregular atrial electrical activity and loss of coordinated atrial contraction.

References

1. Effectiveness and safety of four different beta‐blockers in patients with chronic heart failure. MedComm (2023).
2. Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure. Journal of the American College of Cardiology (2017).
3. Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment. BMC Medicine (2020).
4. Beta-blocker use and cardiovascular event risk in patients with heart failure with preserved ejection fraction. Scientific Reports (2018).
5. Treatment optimization of beta-blockers in chronic heart failure therapy. Scientific Reports (2020).