Effects of Initiating Carvedilol in Patients With Severe Chronic Heart Failure

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Abstract
Beta-blockers prolong life and reduce the risk of disease progression in patients with chronic heart failure,1-6 but they remain underutilized in clinical practice despite their established benefits.7 In part, this underutilization is related to physician concerns that initiation of treatment with a β-blocker is difficult and requires special expertise.8 Patients who start taking a β-blocker may experience decreases in blood pressure as well as retention of sodium,9,10 which can cause symptomatic hypotension and/or worsening heart failure during the first 4 to 8 weeks of therapy.9-14 Furthermore, many physicians have assumed that the beneficial effects of β-blockers are delayed9,15 so that a favorable effect of treatment on symptoms, hospitalizations, or death may not become apparent for many months.2-4,16 Concerns that initiation of β-blocker therapy carries important risks and few immediate benefits has contributed to the underutilization of these drugs in the management of heart failure.7

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