Conventional Wisdom in HF Treatment Challenged Again: Does Heart Rate Lowering Worsen Exercise Intolerance in Heart Failure with Preserved Ejection Fraction?
Modern therapy for HF with reduced EF (HFrEF) is a success story, with multiple classes of pharmacological agents that are safe and effective for improving survival and other key outcomes. It is easily assumed that this success resulted from a straightforward progression of studies from bench to animal model to human hemodynamic testing to large clinical trials. Instead, it was a wild ride. Frequently, the prevailing conventional wisdom was wrong, at least initially, and often repeatedly. Oral inotropes, thought to be the magic bullet, increased mortality. Beta-blockers, thought to be contraindicated, produced the largest improvement in survival.
- Received August 27, 2015.
- Accepted August 31, 2015.