The role of beta-blockers in preventing sudden death in heart failure.

Sudden death accounts for one third to one half of the deaths in patients with heart failure. Recent studies using beta-adrenergic blockers in patients with reduced systolic function and heart failure symptoms have shown significant reductions in overall mortality rates. This article discusses the role of beta-blockers in preventing sudden death in these patients. Six large beta-blocker trials in patients with heart failure have been published to date, with a combined relative risk reduction for sudden death of 38% (confidence interval [CI] 0.53-0.23; P < .001). Although dependent on a nonmechanistic definition of sudden death, the clinical trials of beta-blockers to date have shown that they significantly reduce the risk of sudden death in patients with heart failure. Future studies are required to define the role of other heart failure therapies in the context of this new standard of care.