We recommend all HF patients with an EF ≤40% receive a beta-blocker proven to be beneficial in clinical trials. (Recommendation Strong, Quality High).

We recommend NYHA class IV patients be stabilized before initiation of a beta-blocker. (Recommendation Strong, Quality High).

We recommend therapy be initiated at a low dose and titrated to the target dose used in large trials or the maximum tolerated dose if less than the target dose. (Recommendation Strong, Quality Moderate).

We recommend beta-blocker not be generally introduced to patients with symptomatic hypotension despite adjustment of other therapies, patients with severe reactive airways disease, symptomatic bradycardia or with significant AV block without a permanent pacemaker; stable chronic obstructive pulmonary disease is not a contraindication for use of beta blockade. (Recommendation Strong, Quality Moderate).

Values and Preferences These recommendations place a very high value on the understanding that only beta-blockers that have been shown to improve clinical outcomes should be used.