Beta-blocker management in patients admitted for acute heart failure and reduced ejection fraction: a review and expert consensus opinion
Guillaume Schurtz, Nathan Mewton, Gilles Lemesle, Clément Delmas, Bruno Lévy, Étienne Puymirat, Nadia Aïssaoui, Fabrice Bauer, Édouard Gerbaud, Patrick Henry, Laurent Bonello, Thomas Bochaton, Éric Bonnefoy, François Roubille, Nicolas Lamblin
Abstract
The role of the beta-adrenergic signaling pathway in heart failure (HF) is pivotal. Early blockade of this pathway with beta-blocker (BB) therapy is recommended as the first-line medication for patients with HF and reduced ejection fraction (HFrEF). Conversely, in patients with severe acute HF (AHF), including those with resolved cardiogenic shock (CS), BB initiation can be hazardous. There are very few data on the management of BB in these situations. The present expert consensus aims to review all published data on the use of BB in patients with severe decompensated AHF, with or without hemodynamic compromise, and proposes an expert-recommended practical algorithm for the prescription and monitoring of BB therapy in critical settings.