Beta blockers in CHF; titrate to heart rate, not dose

In this meta-analysis of 23 randomized CHF trials (>95% of patients had systolic dysfunction), pooled analysis showed beta blockers conferred a significant mortality benefit (risk ratio 0.76, CI 0.68-0.84). They did not find an association between mortality and beta blocker dose, but did find a linear association between mortality and heart rate (with an 18% relative risk reduction for every 5 fewer beats per minute). Beta blockers should be titrated by heart rate, not dose, to achieve mortality benefits in patients with systolic CHF (abstract).