American Heart Association Comment: Results Of Cardiac Insufficiency Bisoprolol Study II (CIBIS-II)

December 31, 1998

People with mild to moderate heart failure who were treated with beta-blockers were more likely to survive than individuals who did not receive the drugs, according to a study, CIBIS-II, published in the Jan. 2 issue of Lancet.

Harlan Krumholz, M.D., an American Heart Association spokesperson, who wrote an editorial that accompanied the study, says, "The CIBIS-II trial is an important turning point. Small studies have been accumulating suggesting the value of beta-blockers for patients with heart failure, but this trial provides the first real convincing evidence that patients with mild or moderate heart failure live longer and have less need for hospitalization when treated with beta blockers. Disseminating information about this trial will provide an important public service. We need to get this information to physicians and patients."

In the beta-blocker group there were 34 percent fewer deaths from all causes, and 44 percent fewer sudden deaths. Hospital admissions were 20 percent less among those who received the beta-blocker.

The results of the study suggest that physicians should be using beta-blockers to treat stable patients (someone whose condition is not worsening) with mild to moderate heart failure, first with low doses that should be gradually increased, says Krumholz, associate professor of medicine, Yale School of Medicine.

"The drugs are inexpensive and the benefits are substantial. The message is that we should be looking for opportunities to use these drugs rather than avoid them." Beta-blockers have not been routine drugs for heart failure due to their "depressive" effects on the heart. However, new information about the mechanism of heart failure has led scientists to re-consider the drugs because they may help block the action of some hormones that are released when the heart is damaged.

"These are the same hormones that are released during the 'fight or flight' response and may cause more damage to a weakened heart. It is theorized that beta-blockers may prevent some of the damage from these hormones," he says. The results of the study are not conclusive for those with very severe heart failure. "We need more information about these groups," says Krumholz. "CIBIS-II enrolled mostly patients who had mild to moderate heart failure."

The CIBIS-II trial recruited 2,647 individuals who had stable, symptomatic heart failure (New York Heart Association Class II-IV). All individuals had left ventricular systolic dysfunction (an impaired left ventricle, the main pumping chamber of the heart) with an ejection fraction less than 35 percent, an indication that the heart is pumping inefficiently. Participants were treated with standard therapy for heart failure including diuretics and ACE inhibitors. Half of the patients also received the beta-blocker bisoprolol at a dose starting at 1.25 milligrams per day, increasing to a maximum dose of 10 mg per day during the following six months.

The trial was stopped prematurely because of a benefit in favor of bisoprolol. During an average follow-up period of 1.3 years, 11.8 percent of patients on bisoprolol died, compared with 17.3 percent of those who received placebo.
For more information about beta-blockers contact the American Heart Association's website at

For additional information please contact Carole Bullock of the AHA's News Media Relations department at 214-706-1279.

American Heart Association

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