Expert consensus document on ?-adrenergic receptor blockersThe Task Force on Beta-Blockers of the European Society of Cardiology

Abstract

Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and by different organisations and other related societies. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents. In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied with in the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. The ESC Committee for Practice Guidelines (CPG) supervises and coordinates the preparation of new Guidelines and Expert Consensus Documents produced by Task Forces, expert groups or consensus panels. The chosen experts in these writing panels are asked to provide disclosure statements of all relationships they may have which might be perceived as real or potential conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. The Committee is also responsible for the endorsement of these Guidelines and Expert Consensus Documents or statements. The Task Force has classified and ranked the usefulness or efficacy of the recommended procedure and/or treatment and the Level of Evidence as indicated in the tables below: Evidence and/or general agreement that a given procedure/treatment is beneficial, useful and effective; Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the procedure/treatment; Weight of evidence/opinion is in favour of usefulness/efficacy; Usefulness/efficacy is less well established by evidence/opinion; Class III*: Evidence or general agreement that the treatment is not useful/effective and in some cases may be harmful. *Use of Class III is discouraged by the ESC Data derived from multiple randomised clinical trials or meta-analyses Data derived from a single randomised clinical trial or non-randomised studies Consensus of opinion of the experts and/or small studies β-Blocker therapy plays a major role in the treatment of cardiovascular diseases. For many years β-blockers were used for their antiischaemic, antiarryhthmic and antihypertensive properties. More recently, the benefit of adrenoceptor blockade was also established in patients with heart failure. The aim of this document is to review the rationale and clinical evidence for the use of β-adrenergic blockers in patients with cardiovascular disease. The members for the Beta-blockers in Cardiovascular Disease Task Force were nominated by the Committee for Practice Guidelines (CPG) of the European Society of Cardiology (ESC). A specific literature search was carried out for original articles in peer review journals included in Medline. In addition, the ESC as well as the American Heart Association/American College of Cardiology guidelines with reference to the use of β-blockers were carefully reviewed. Most of the previously made recommendations were maintained; some were updated and a few are new according to recent evidence in the literature. Using recommendations which are graded provides a simple method for guidance. Levels of recommendation are derived from clinical trials, conducted in selected groups of patients that may not be representative of broader populations; in fact, patients with contraindications are excluded from clinical trials. Besides, the same strength of evidence may reflect different clinical benefit: mortality, morbidity, clinical symptoms or combined end-points; large or small benefit albeit statistically significant; easily obtained or only observed, or lost, after several years of treatment. Finally, in individual cases the recommended therapy may only be a treatment option and other alternatives may be equally acceptable or even more appropriate. An effort was made to include this information in a relatively short document. The document prepared by the task force was circulated among a review board appointed by the ESC and approved by the Committee for Practice Guidelines of the ESC. The final document was sent to the European Heart Journal for a formal peer review. This consensus document represents the views of