- Question
- Can bisoprolol, a beta1-selective blocker, reduce all-cause mortality in patients with chronic heart failure?
- Design
- Multicentre European double-blind, randomised, placebo-controlled trial of 2647 patients with a mean follow-up of 1.3 years. Analysis was by intention to treat, and the trial was stopped early after the second interim analysis because of a mortality benefit.
- Population
- Symptomatic patients in NYHA class III or IV with a left-ventricular ejection fraction of 35% or less, receiving standard therapy with diuretics and angiotensin-converting enzyme inhibitors.
- Intervention
- Bisoprolol starting at 1.25 mg daily (n=1327), progressively increased to a maximum of 10 mg per day.
- Control
- Daily placebo (n=1320), with the same progressive titration schedule.
- Primary outcome
- All-cause mortality.
- Results
- All-cause mortality was lower with bisoprolol than with placebo (156 [11.8%] vs 228 [17.3%] deaths; HR 0.66, 95% CI 0.54-0.81, p<0.0001). Sudden deaths were also fewer with bisoprolol (48 [3.6%] vs 83 [6.3%]; HR 0.56, 95% CI 0.39-0.80, p=0.0011).
- Conclusion
- Bisoprolol improved survival in patients with stable heart failure, with a treatment effect independent of the severity or cause of heart failure.
- Why it matters
- It provided evidence that adding a beta-blocker to standard therapy reduces mortality in heart failure with reduced ejection fraction, helping to establish beta-blocker use in these patients. The authors cautioned that results should not be extrapolated to patients with severe class IV symptoms and recent instability.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026