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-Blockade for Patients With Heart Failure

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Hjalmarson and colleagues¹ provide data indicating that -blockers reduce the mortality rate in patients with chronic heart failure (CHF). They go on to state the need to assess other clinical outcomes. This raises obvious ethical issues of withholding proven therapy. This concern would remain even if the treatment in question became "standard of care" after the study was under way. In such a case, the trial should be ended or modified so that all patients would receive appropriate treatment.

We are also concerned that about 50% of patients in each treatment group were survivors of myocardial infarction (MI). While few MIs appeared to be recent (8% were within a year of randomization), there was no further characterization of acuity. To deny such patients treatment with a -blocker was potentially a breech of professional and ethical standards. The American College of Cardiology and American Heart Association are . . . [Full Text of this Article]

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Effects of Controlled-Release Metoprolol on Total Mortality, Hospitalizations, and Well-being in Patients With Heart Failure: The Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF)
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