Rosh Internal Medicine Boost Practice Exam

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Which class of medications has been shown to increase survival in patients with heart failure and reduced ejection fraction?

Beta-blockers
Calcium channel blockers
Loop diuretics
Thiazide diuretics

The correct answer is: Beta-blockers

Beta-blockers are a class of medications that have been demonstrated to improve survival in patients with heart failure and reduced ejection fraction (HFrEF). The mechanism by which beta-blockers confer these benefits includes their ability to block the effects of catecholamines (like adrenaline) on the heart, which can be detrimental in heart failure. In heart failure, increased sympathetic nervous system activity can lead to further deterioration of the heart's function. Beta-blockers help to slow the heart rate, reduce myocardial oxygen demand, and improve diastolic filling, thereby enhancing the overall efficiency of the heart. Additionally, they have been shown to remodel the heart positively over time, leading to improved cardiac function and reduced morbidity and mortality. Clinical trials, such as the CARVEDILOL and METOPROLOL studies, have specifically highlighted the role of beta-blockers in prolonging survival and improving quality of life for patients with HFrEF. This is why beta-blockers are a cornerstone in the pharmacological management of this condition, contrasting with other options like calcium channel blockers, loop diuretics, and thiazide diuretics, which do not have the same evidence of survival benefit in this patient population.