Which class of medications has been shown to reduce mortality in heart failure with reduced ejection fraction?

• A. Calcium Channel Blockers
• B. Loop Diuretics
• C. Nitrates
• D. Beta-blockers

Answer: (D)

Beta-blockers have been shown to reduce mortality in heart failure with reduced ejection fraction. In this condition, the heart and circulation become dominated by chronic sympathetic activation, which initially helps maintain output but over time worsens remodeling, promotes arrhythmias, and accelerates decline. Blocking beta-adrenergic receptors lowers heart rate, reduces myocardial oxygen demand, and limits harmful remodeling, leading to improved survival. Large trials demonstrated mortality benefits with agents like metoprolol succinate and carvedilol, and with bisoprolol, with additional gains in fewer hospitalizations and improved function over time. Other options mainly address symptoms or have less clear survival benefits in HFrEF, so the class with proven mortality reduction is beta-blockers.