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July 26, 2000

β-Blockade for Patients With Heart Failure—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(4):436-437. doi:10.1001/jama.284.4.436

In Reply: Drs Rifkin and Walerstein question whether it might have been unethical to conduct the MERIT-HF study among patients with previous MI because there was already sufficient evidence of benefit of β-blockade in patients with CHF. However, when the MERIT-HF study started in February 1997, there was no published randomized, double-blind, placebo-controlled study of β-blockade in chronic CHF that was adequately powered for a primary analysis of survival effects. In addition, CHF was a relative contraindication for using β-blockade in patients with MI. The results of the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II) study,1 showing a survival benefit of bisoprolol, was published in 1999, after the premature closure of the MERIT-HF study, which took place in October 1998. The results regarding mortality outcome in the MERIT-HF study were published in June 19992 and were followed by our article in JAMA, presenting the effects on hospitalizations, symptoms, and quality of life. Hence, the overwhelming documentation of the favorable effect of β-blockade on mortality in CHF was obtained largely in parallel from 2 studies, which were both published within a 12-month period.