Which beta-blockers have proven mortality benefit in HFrEF?

• A. Carvedilol, metoprolol succinate, and bisoprolol
• B. Propranolol, labetalol, nadolol
• C. Atenolol, acebutolol, timolol
• D. Nebivolol, pindolol, sotalol

Answer: (A)

The main concept is that only certain beta-blockers have been shown to actually improve survival in heart failure with reduced ejection fraction (HFrEF) when added to guideline therapy. The ones with proven mortality benefit are carvedilol, metoprolol succinate, and bisoprolol. Large randomized trials demonstrated that these three reduce the risk of death in HFrEF patients: carvedilol in COPERNICUS, metoprolol succinate in MERIT-HF, and bisoprolol in CIBIS-II. Because of this solid evidence, they are recommended as disease-modifying therapy for HFrEF.

The other beta-blockers listed have not shown a consistent mortality benefit in large HF trials, so they aren’t considered proven mortality-benefit options in HFrEF, though they may be used for other conditions or contexts.