What is the main benefit of using β-blockers in heart failure management?

Using β-blockers in heart failure management primarily offers the benefit of decreasing sympathetic drive. In heart failure, the body compensates for decreased cardiac output by activating the sympathetic nervous system, which can lead to a range of detrimental effects, including increased heart rate, increased myocardial oxygen demand, and eventual worsening of heart failure symptoms.

By blocking β-adrenergic receptors, β-blockers reduce this excessive sympathetic stimulation. This helps to decrease heart rate and myocardial contractility, leading to lower myocardial oxygen consumption and less strain on the heart. Moreover, by mitigating the harmful effects of chronic sympathetic activation, β-blockers can improve cardiac remodeling over time. This ultimately contributes to improved clinical outcomes in patients with heart failure, making them an essential component of heart failure pharmacotherapy.

In contrast, while β-blockers may have some indirect effects on stroke volume and cardiac output, their primary mechanism and benefit come from the reduction of sympathetic drive, which stabilizes heart function and enhances patient prognosis. Improved end-organ perfusion is a consequence of better heart function but is not the primary action of β-blockers.