A major heart failure discovery over the last 20 years is that the excessive activation of the body's neurohormonal (regulation) systems leads to PROGRESSION of symptoms and severity of heart failure. Sudden death can occur even in the presence of only minimal symptoms. Specifically, high levels of the body's regulation hormones angiotensin and norepinephrine can lead to worsening of the heart's function as a pump. Patients with symptoms of heart failure can take medications that block the effects of these hormones and improve how they feel and live longer.

Studies with the beta-blocker Carvedilol have found improved symptoms and survival in patients with an ejection fraction less than or equal to 40%.

When:

• Symptoms of heart failure are present with activity.
• Symptoms of severe heart failure are present at rest
• No symptoms are present following a heart attack (myocardial infarction).

Metoprolol (Toprol XL) and bisoprolol are alternative beta-blockers shown to improve survival in patients with symptoms of heart failure.