More than 25 years ago, Swedish physicians reported that β-blocker therapy can improve symptoms and ventricular function in patients with overt heart failure due to dilated cardiomyopathy.1 These reports created substantial disbelief and skepticism among cardiologists and practicing physicians. The pharmacodynamic effects of β-blockers, such as decrease in heart rate, blood pressure, and contractile function, were already established. It is not surprising, therefore, that physicians were not only hesitant but also afraid to use β-adrenergic blocking agents, which have the potential to cause worsening heart failure due to their negative inotropic effects.
Chatterjee K. The Fear of β-Blocker Therapy in Heart FailureTime to Forget. Arch Intern Med. 2004;164(13):1370-1371. doi:10.1001/archinte.164.13.1370