In heart failure with reduced ejection fraction (HFrEF), what is the expected outcome after initiating beta-blocker therapy and achieving stabilization?

• A. Reduced mortality by lowering risk of remodeling and arrhythmias.
• B. Immediate increase in ejection fraction within days.
• C. Worsening of heart failure due to negative inotropy.
• D. No meaningful change in survival.

Answer: (A)

When beta-blockers are started in heart failure with reduced ejection fraction and the patient has been stabilized, the main expected outcome is a reduction in mortality. This benefit comes from reducing the harmful effects of chronic sympathetic activation: they slow heart rate, lessen myocardial oxygen demand, and help prevent adverse remodeling of the ventricle that leads to dilation and electrical instability. By cutting down on remodeling and arrhythmias, long-term survival improves.

It's worth noting that there isn’t an immediate jump in ejection fraction right after initiation; any initial risks of worsening symptoms are typically managed during careful dose titration. Options claiming an immediate EF increase, or no survival benefit, or ongoing worsening with no meaningful change in survival don’t align with the established long-term benefits of beta-blockers in this setting.