Guideline Recommended Practice

Prescribing Beta Blocker therapy to patients with LV Systolic Dysfunction

Use of 1 of the 3 beta blockers proven to reduce mortality is recommended for all stable patients with current or prior symptoms of heart failure and reduced LVEF.

Unless contraindicated, patients with LV systolic dysfunction should be treated with one of the three following beta-blockers:

  • carvedilol*
  • sustained-release metoprolol (succinate)
  • bisoprolol

Beta blocker treatment should be initiated:

  • At very low doses and gradually increased if lower doses are well tolerated.
  • As soon as LV dysfunction is diagnosed.

Beta blocker treatment should not be:

  • Prescribed without diuretics in patients with current or recent history of fluid retention.
  • Prescribed to patients with higher degree AV heart block, and should be used with caution in those with second degree AV block.
  • Prescribed for initiation in patients with acute HF symptoms or decompensated HF.
  • (If a non-cardioselective beta blocker (e.g., carvedilol)), prescribed to patients with significant asthma or bronchostrinction, especially if with a positive methacholine challenge.

*Both the immediate-release and extended-release carvedilol may be prescribed for heart failure.

Performance Measure Reporting

What's Being Measured

Percentage of patients ≥18 years of age diagnosed with heart failure, with a current or prior LVEF < 40%, who were prescribed beta-blocker therapy within a 12 month period from when seen either in the outpatient setting or at hospital discharge.

How to Satisfy this Measure

Prescribe* and document beta-blocker therapy of either carvedilol sustained release metoprolol succinate, or bisoprolol for patients ≥18 years with HF who have a current or prior LVEF < 40%.


Document contraindication(s) to beta-blocker. At least one of these exceptions must be documented in the patient record lieu of prescription, if they apply:

  • Medical reason(s) for not prescribing beta-blocker therapy
    • For example: low blood pressure, fluid overload, volume depletion, asthma, recently treated with intravenous positive inotropic agent
  • Patient reason(s) for not prescribing beta-blocker therapy
  • System reason(s) for not prescribing beta-blocker therapy
    • For example: not covered by insurance plan

*Prescribe may include prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking betablocker therapy as documented in current medication list

SPECIAL NOTE: This measure is paired with performance measure "Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction".
They must be implemented together.