beta-blockers in left ventricular systolic dysfunction--from evidence to practice

Five percent of all hospital medical admissions are patients with heart failure. The incidence is about one new case per 1000 of the general population per year, increasing to >10 per 1000 in those aged >or=85 years. Although the evidence that beta-blockers reduce mortality by about 36% when added to angiotensin-converting enzyme inhibitors is overwhelming, clinicians are still reluctant to use beta-blockers in heart failure, especially in older patients. Here, we examine the evidence for the use of beta-blockers in heart failure in older people and explore the practicalities of their use.