Eligibility criteria for beta-blockade might have to be taken into account.

摘要

The results of the study showing significantly more readmissions for heart failure in patients treated with evidence-based beta-blockers than in their beta-blocker naive counterparts1 need to be interpreted in the light of eligibility criteria for this treatment modality. In one study, in which carvedilol generated a significant survival benefit and a significant reduction in the combined risk of death or hospitalization, eligible patients were those with left ventricular systolic dysfunction who, despite "dyspnoea or fatigue at rest or on minimal exertion," were, nevertheless, clinically euvolaemic. Conversely, in an earlier study, patients with heart failure (left ventricular systolic function and blood volume status undefined) in whom the beta-blocker challenge had failed with a worsening of heart failure were characterized by New York Heart Association (NYHA) functional class III and IV, and those with conditions that did not deteriorate with the challenge were either in functional class II or class III. In a more recent study, beta-blockade did not significantly influence survival or hospital readmission rates in patients with heart failure with intact left ventricular systolic function, and the condition of these patients deteriorated despite such treatment. More sophisticated modalities might be needed to characterize eligibility for beta-blockade in heart failure, and these might include an evaluation of anti-fi-adreno-receptor autoantibodies, which have higher levels in patients with more advanced NYHA functional class and myo-cardial sympathetic nerve activity. It might even be necessary to "investigate serial changes in anti-beta1 adre-noreceptor autoantibody levels before and during beta-blocker therapy, and compare those changes between carvedilol and selective beta 1-receptor blockers" so as to compare different beta-blockers and to predict relapse.