Can beta blockers be safely initiated at home in patients with heart failure

Sir, Beta‐blockers reduce mortality and morbidity in chronic heart failure.1,,2 Concerns over syncope secondary to hypotension or bradycardia, and acute deterioration in heart failure symptoms on initiating such therapy, have lead to recommendations that first doses be given over several hours of medical supervision and monitoring, but evidence for the need for this practice is lacking.3 Whether beta blocker therapy can be safely introduced at home in patients with chronic heart failure is unknown, and is relevant to the development of community‐based heart failure services. We conducted a study at two district general hospitals in the South of England (St. Richard's Hospital, Chichester and St. Mary's Hospital, Portsmouth). Both operated heart failure clinics, and patients qualified for beta‐blockers (bisoprolol) if they had stable grade II–IV heart failure and were already taking …