Patient groups with chronic heart failure who should not be prescribed beta blockers

Patient groups with chronic heart failure who shouldn't be prescribed a beta-blocker (1):

• contra-indicated in patients who have asthma with reversible airways obstruction - note however that most patients with chronic obstructive pulmonary disease (chronic bronchitis and emphysema) do not have much reversible airways obstruction and can be given beta-blockers safely
  • if in doubt, pulmonary function testing should be undertaken
• peripheral vascular disease
  • most patients with peripheral vascular disease can be given beta-blockers safely, however they are contraindicated in critical limb ischaemia
• beta-blockers should not be given to patients with decompensated heart failure and patients should be free of signs of fluid retention prior to commencement
• beta-blockers should not be given to patients requiring intensive care for their heart failure in an ICU or when they are on inotropes
• heart block
  • patients with second or third degree heart block should receive a pacemaker before beta-blockers are prescribed

Reference:

1. British Heart Foundation. Factfile 4/06 - Use of beta blockers in heart failure.