Treatment of chronic cardiac insufficiency with betablockers: results of the Cardiac Insufficiency Bisoprolol Study II (CIBIS II)

Journal of Clinical and Basic Cardiology 2000; 3 (1): 11-13

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Keywords: Betablocker,  Bisoprolol,  CIBIS-II,  Herzinsuffizienz,  beta-blocker,  Bisoprolol,  cardiac insufficiency,  CIBIS-II

Despite basic therapy consisting of digitalis, diuretics and ACE inhibitors, severe cardiac insufficiency based on ischaemic or dilatory cardiomyopathy still has a high morbidity and mortality. Based on recent pathophysiological findings related to cardiac insufficiency with an activation of the sympathicoadrenergic system, and the results of numerous clinical trials, adjuvant therapy with betablockers has become an integral part of the treatment of cardiac insufficiency, provided there are no contra-indications. In addition to an improvement of the symptoms and the systolic pump function of the left ventricle, the advantage of this additional medication lies primarily in the beneficial influence on morbidity and mortality. The improved prognosis has been demonstrated by the US Carvedilol Study, as well as the two more recent major randomized studies CIBIS II and MERIT-HF. Both studies were able to show that this additive therapeutic measure can be implemented with a very high level of safety, even in non-specialized clinics, if the initial dose is low, the patient is monitored carefully, and the dosage is gradually increased at weekly intervals. It may be hoped that these studies will reinforce the physicians? confidence in betablocker therapy for cardiac insufficiency, and that more and more patients will have the benefit of receiving this treatment as a result. A clear answer to the question of whether there are any substance-specific differences between the betablockers and which patient populations (aetiology, severity of cardiac insufficiency) can profit most from this therapy is expected to result from the on-going multicenter studies (COPERNICUS, CAPRICORN, CARMEN, COMET) with several thousands of patients. J Clin Basic Cardiol 2000; 3: 11-3.