Switching to Once-Daily Evidence-Based β-Blockers in Patients With Systolic Heart Failure or Left Ventricular Dysfunction After Myocardial Infarction

Reducing dosing frequency for patients with heart failure simplifies the medication plan and may improve adherence to prescribed medications. The author discusses the practical considerations of the use of evidence-based β-blockers.

Polypharmacy, the use of multiple medications resulting in complex drug regimens, is increasing among patients with heart failure.¹ Ideally, at discharge from the hospital, each patient should be prescribed evidence-based medications (ie, medications that published evidence indicates are effective for the patient’s condition). The list of such medications is becoming long. According to the National Heart Care Project for 2000–2001, the mean numbers of heart failure medications and doses per day were 7.5 and 11.1, respectively.² National guidelines rarely address the problem of polypharmacy for high-risk patients, and they do not consider patients’ adherence, the risk of adverse effects, or pharmacoeconomic considerations. Patients who have had a myocardial infarction, especially those who have concomitant heart failure, are...