Skip Navigation

This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Lechat, P.
Right arrow Articles by Willenheimer, R.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Lechat, P.
Right arrow Articles by Willenheimer, R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Discussion summary: key clinical questions

Philippe Lechat* and Ronnie Willenheimer, (Symposium Chairmen)

Service de Pharmacologie, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France

* Corresponding author. Tel: +33 1 42 16 16 82; fax: +33 1 42 16 16 88. E-mail address: philippe.lechat@psl.ap-hop-paris.fr

The first 150 words of the full text of this article appear below.


   Can the benefits of beta-blockade in CHF be considered a class effect?
 
It is probable that the efficacy of beta-blockers in CHF is attributable to beta1-blockade. However, there are differences between beta-blockers in their pharmacological properties, which may translate into differences in effects on morbidity, mortality, quality-of-life, and physical function. The European Society of Cardiology guidelines clearly state that the only beta-blockers proven to reduce morbidity and mortality in large randomized trials are bisoprolol, carvedilol, metoprolol succinate CR/XL, and nebivolol, and that these are the agents from which physicians should choose.1


   Could beta-blockers and ACE-inhibitors be initiated simultaneously in CHF?
 
A survey of the audience through interactive voting revealed this to be a surprisingly widespread practice. However, as the panel pointed out, simultaneous initiation has never been examined in a randomized controlled outcome trial, and therefore cannot be considered evidence-based. Moreover, there are potential problems in trying to uptitrate two drugs simultaneously. The risk of side-effects is greater, and if they occur, the physician will not know which drug should . . . [Full Text of this Article]


   Could both treatments be combined in a single pill?
 

   How important is it to adhere to the target doses of beta-blockers used in clinical trials?
 

   Can we achieve target doses of both the beta-blocker and the ACE-inhibitor?
 

   What factors can contribute to the successful initiation of beta-blockers?
 

   Is there a clearly defined subgroup of patients in whom beta-blockers should be initiated first?
 

   Can beta-blockers be used in patients with chronic obstructive pulmonary disease (COPD)?
 

   Is 6 months of monotherapy used in CIBIS-III appropriate for everyday clinical practice?
 

   Why was enalapril chosen as the ACE-inhibitor in CIBIS-III?
 

   Can long-term monotherapy with a beta-blocker ever be recommended in CHF?
 

   Why were both per-protocol and intention-to-treat analyses of the primary endpoint reported in CIBIS-III?
 

   Why was CIBIS-III not double-blind?
 

   Why did CIBIS-III not include NYHA Class IV patients?
 

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?