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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2007; 50:563-572, doi:10.1016/j.jacc.2007.04.060 (Published online 29 July 2007).
© 2007 by the American College of Cardiology Foundation
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Cardiovascular Protection Using Beta-Blockers

A Critical Review of the Evidence

Sripal Bangalore, MD, MHA*, Franz H. Messerli, MD*,*, John B. Kostis, MD{dagger} and Carl J. Pepine, MD{ddagger}

* St. Luke's-Roosevelt Hospital and Columbia University, New York, New York
{dagger} University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
{ddagger} University of Florida College of Medicine, Gainesville, Florida


Figure 1
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  		Figure 1 Number Needed to Treat in Major Randomized Controlled Trials of Beta-Blockers for Heart Failure

Treatment of 15 to 43 patients with heart failure prevents 1 death and, thus, beta-blockers are very effective in patients with heart failure. CAPRICORN = CArvedilol Post infaRction SurvIval COntRol in left ventricular dysfunctioN; CIBIS = Cardiac Insufficiency Bisoprolol Study; COPERNICUS = CarvedilOl ProspEctive RaNdomIzed CUmulative Survival Trial; MERIT-HF = MEtoprolol CR/XL Randomized Intervention Trial in chronic Heart Failure.

 

Figure 2
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  		Figure 2 Overview of Major Meta-Analyses of Randomized Controlled Trials of Beta-Blockers in Patients With Heart Failure

In patients with heart failure, beta-blockers are efficacious agents for the prevention of cardiovascular events. ACEi = angiotensin-converting enzyme inhibitors; ARBs = angiotensin receptor blockers; BB = beta-blocker; CI = confidence interval; HR = hazard ratio; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association.

 

Figure 3
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  		Figure 3 Proposed Use of Beta-Blockers for Hypertension

In patients with uncomplicated hypertension, beta-blockers should not be used as first-line agents. However, in patients with uncontrolled hypertension on various other antihypertensive agents and in those with complicated hypertension, beta-blockers should be considered in the armamentarium of treatment. CHF = chronic heart failure; MI = myocardial infarction.

 
 
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