Among beta-blockers used in heart failure with reduced ejection fraction, only three have demonstrated mortality benefit in randomized trials. Which of the following has NOT shown mortality reduction in HFrEF?

• A Carvedilol
• B Metoprolol succinate (extended release)
• C Bisoprolol
• D Metoprolol tartrate (immediate release) ✓

Explanation

Carvedilol (COPERNICUS), metoprolol succinate (MERIT-HF), and bisoprolol (CIBIS-II) have proven mortality benefit in HFrEF. Metoprolol tartrate, the immediate-release formulation, was not used in a positive mortality trial in heart failure. Current guidelines specify the extended-release succinate formulation. All four are beta-blockers, but only the three with trial evidence are recommended.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.