Why is metoprolol used in heart failure
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The Role of Metoprolol in Heart Failure Management
Introduction to Metoprolol in Heart Failure
Metoprolol, a selective beta1-adrenergic antagonist, has been extensively studied and utilized in the management of heart failure (HF). Despite its known cardiodepressant effects, metoprolol has demonstrated significant benefits in improving heart function and patient outcomes in various clinical trials.
Improved Survival and Reduced Mortality
One of the primary reasons metoprolol is used in heart failure is its ability to improve survival rates. The Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF) showed that metoprolol controlled release/extended release (CR/XL) significantly reduced all-cause mortality in patients with chronic heart failure. The study reported a 34% reduction in relative risk of all-cause mortality and a significant decrease in sudden deaths and deaths due to worsening heart failure2 4 8.
Enhanced Left Ventricular Function
Metoprolol has been shown to improve left ventricular (LV) function, which is crucial in heart failure management. Studies have demonstrated that metoprolol therapy leads to an increase in ejection fraction and a reduction in LV volumes. For instance, patients treated with metoprolol CR showed significant improvements in LV end-diastolic and end-systolic volumes, as well as an increase in ejection fraction3 9. These improvements in LV function contribute to better overall cardiac performance and patient outcomes.
Reduction in Hospitalizations
Another significant benefit of metoprolol in heart failure is the reduction in hospitalizations. The MERIT-HF study and other trials have consistently shown that metoprolol therapy reduces the number of hospital admissions due to heart failure exacerbations. This reduction in hospitalizations not only improves the quality of life for patients but also decreases healthcare costs1 5.
Improved Exercise Capacity and Symptoms
Metoprolol has been associated with improvements in exercise capacity and symptoms in heart failure patients. Clinical trials have reported that patients on metoprolol therapy experienced significant improvements in exercise duration and New York Heart Association (NYHA) functional class. These improvements indicate better physical functioning and reduced symptoms of heart failure, contributing to an enhanced quality of life1 10.
Neurohumoral Modulation
Metoprolol also plays a role in modulating neurohumoral activation, which is often dysregulated in heart failure. Studies have shown that metoprolol therapy leads to a decrease in angiotensin II and renin levels, which are part of the renin-angiotensin-aldosterone system (RAAS). This modulation helps in reducing the harmful effects of chronic neurohumoral activation in heart failure patients3.
Conclusion
Metoprolol is a cornerstone therapy in the management of heart failure due to its multifaceted benefits. It improves survival rates, enhances left ventricular function, reduces hospitalizations, and improves exercise capacity and symptoms. Additionally, its role in neurohumoral modulation further supports its use in heart failure management. These benefits make metoprolol a valuable drug in the treatment of heart failure, contributing to better patient outcomes and quality of life.
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Most relevant research papers on this topic
Beneficial effects of metoprolol in heart failure associated with coronary artery disease: a randomized trial.
Titrated metoprolol is safe and beneficial when added to standard heart failure therapy in patients with dilated cardiomyopathy associated with coronary artery disease.
RCT
Highly CitedEffect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF)
Metoprolol CR/XL once daily in addition to standard therapy improved survival in chronic heart failure patients with decreased ejection fraction and symptoms, and was well-tolerated.
RCT
Large Human TrialHighly CitedEffects of metoprolol CR in patients with ischemic and dilated cardiomyopathy : the randomized evaluation of strategies for left ventricular dysfunction pilot study.
Metoprolol CR improves left ventricular function, reduces renin-angiotensin system activation, and leads to fewer deaths in patients with symptomatic congestive heart failure.
RCTLarge Human TrialHighly CitedRationale, design, and organization of the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF). The International Steering Committee.
Metoprolol CR/XL may reduce mortality and hospitalizations in patients with congestive heart failure when added to standard therapy.
RCTLarge Human TrialMetoprolol controlled release/extended release in patients with severe heart failure: analysis of the experience in the MERIT-HF study.
Metoprolol CR/XL treatment significantly reduces mortality and hospitalizations for worsening heart failure in patients with severe heart failure.
RCTLarge Human TrialHighly CitedProspective, randomized comparison of effect of long-term treatment with metoprolol or carvedilol on symptoms, exercise, ejection fraction, and oxidative stress in heart failure.
Carvedilol and metoprolol both show parallel beneficial effects on symptoms, exercise, ejection fraction, and oxidative stress in heart failure patients over 6 months.
RCTHighly CitedRole of Metoprolol Succinate in the Treatment of Heart Failure and Atrial Fibrillation: A Systematic Review.
Metoprolol succinate remains a useful drug for treating heart failure and atrial fibrillation, with significant mortality and morbidity benefits compared to other beta-blockers.
Systematic ReviewMetoprolol: a review of its use in chronic heart failure.
Metoprolol CR/XL effectively decreases mortality and improves clinical status in patients with stable mild to moderate chronic heart failure due to left ventricular systolic dysfunction, and is effective in patients with ischaemic or dilated cardiomyopathy.
Literature ReviewIncreased beta-receptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy.
Long-term metoprolol therapy improves myocardial beta-receptor density, resting hemodynamic output, and contractile response to catecholamine stimulation in patients with dilated cardiomyopathy.
Non-RCTHighly CitedImprovement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial.
Metoprolol can safely improve symptoms and exercise capacity in patients with dilated cardiomyopathy, with seven out of 20 patients experiencing resolution of heart failure symptoms and doubled their exercise capacity.
RCTHighly Cited