Atrial fibrillation (AF) is common among patients with heart failure (HF)
Treatment recommendations for patients with HFrEF are displayed
Specific beta-blockers such as carvedilol and metoprolol succinate (ie, long-acting metoprolol) improve left ventricular ejection fraction, survival, In HFrEF, after initial
The Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure extended the evidence of beta-blockers to those with an LVEF ≤40% and
Post-hoc analyses of the Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF) (100 mg/day, 200 mg/day) and the Cardiac Insufficiency
Because both these drugs are now available generically, a pragmatic randomized controlled trial to study the efficacy of these drugs in HFrEF (focused on both arrhythmic and nonarrhythmic outcomes) is warranted
Metoprolol, for example, is readily cleared by dialysis, whereas bisoprolol and carvedilol are less dialyzable
Metoprolol is contraindicated in patients with decompensated HFrEF and hypoperfusion (acute kidney/liver injury, elevated lactate, relative hypotension, narrow pulse pressure)
[58, 59] Another meta-analysis comparing the effects of carvedilol to metoprolol on LVEF in HF patients revealed that carvedilol lead to greater improvement on LVEF than metoprolol at similar doses
The average EF was 48
Atrial fibrillation (AF) is a medical problem of increasing prevalence often associated with multiple comorbidities and adverse outcomes
At first, this may involve 3 different medicines from 3 different drug classes: a diuretic, an agent that blocks the renin-angiotensin system (ACE inhibitor, ARB or ARNI), and a beta blocker
Among the many types and classifications of BBs, three drugs (bisoprolol, sustained release metoprolol succinate, and carvedilol) have been shown to be effective in reducing the risk of death in patients with HFrEF [3-6]
The pharmacologic interventions that have demonstrably reduced all-cause or cardiovascular (CV) mortality in HFrEF with LVEF <40% have not had the same effect as EF increases but have decreased HF hospitalizations in this group
In HFrEF patients with AF, there was no difference in total adverse events in patients treated with IV diltiazem compared to metoprolol
In heart failure with reduced ejection fraction (HFrEF), systolic function is impaired [4]
The COMET trial is the largest RCT comparing different beta-blockers in HFrEF
They’re helpful medications for people with heart failure, heart arrhythmias, and a history of heart attack