Beta-blocker therapy in advanced heart failure: Clinical characteristics and long-term outcomes

Christopher M. O'Connor*, Wendy A. Gattis, Faiez Zannad, Steven E. McNulty, Mihai Gheorghiade, Kirkwood F. Adams, Robert M. Califf, William J. McKenna, Jordi Soler-Soler, Karl Swedberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Aims: To evaluate the clinical characteristics and long-term outcomes of advanced heart failure patients (NYHA Class IIIb-IV) receiving beta-blocker therapy vs. those patients not receiving beta-blockers at randomization in the FIRST trial, a randomized, double-blind, placebo-controlled trial of epoprostenol vs. usual care in advanced heart failure. Methods and results.' The patient population consisted of 471 patients enrolled in FIRST with Class IIIb-IV heart failure, left ventricular ejection fraction (LVEF) of < 30%, advanced hemodynamic abnormalities, and standard pharmacologic treatment of ACE-inhibitor, diuretics, and/or digoxin. The study cohort consisted of 448 patients not receiving beta-blockers and 23 patients receiving beta-blockers at randomization for the FIRST trial. Patients in the beta-blocker group had decreased rates of any clinical event (P = 0.03), worsening heart failure (P = 0.001), and death or worsening heart failure (P = 0.0008) than patients not receiving beta-blockers. After adjusting for prognostically important variables, the favorable effect of beta, blockers on worsening heart failure (P = 0.02) and death or worsening heart failure (P = 0.02) persisted. Conclusion: Patients with advanced heart failure who receive beta-blocker therapy have a lower rate of hospitalization and are less likely to experience worsening heart failure or death at 6 months than patients who are not treated with beta-blockers. These observational data contribute to the growing body of data demonstrating a favorable effect of beta-blockers on clinical outcomes in heart failure. (C) 1999 European Society of Cardiology.

Original languageEnglish (US)
Pages (from-to)81-88
Number of pages8
JournalEuropean Journal of Heart Failure
Issue number1
StatePublished - Mar 2000


  • Advanced heart failure
  • Beta-blockers
  • Mortality
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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