Beta-blockers for congestive heart failure in children

The term congestive heart failure describes a disorder in which the heart is unable to sufficiently and efficiently pump blood through the body. Depending on the severity of the condition, this causes breathlessness and fatigue due to insufficient oxygen supply as well as accumulation of fluids in tissues and organs. In children, congestive heart failure is mainly due to congenital heart defects. Drug treatment, depending on the specific condition, may be used for long-term control of heart failure, or to bridge the time until corrective surgery. For dilated or restrictive cardiomyopathy, a disorder with a high mortality, heart transplantation remains the only option when drug treatment fails. Beta-blockers have proven beneficial and even life-saving in adults with congestive heart failure and are therefore part of the standard treatment. For children, similar benefits have to be expected, but beta-blockers are, if at all, used off-label. Since in children the causes for heart failure are different from those in adults, the main effect as well as adverse events may differ. In addition dosing might have to be specifically adapted for different age groups. This review therefore summarises and discusses the available information on the use of beta-blockers in children with congestive heart failure. Three studies with 20, 22 and 161 patients respectively were included in the review. While the two smaller trials were able to show an improvement of heart failure with beta-blocker therapy, the trial with 161 participants did not show a significant effect of the investigated beta-blocker over placebo. Neither of the studies reported any severe beta-blocker related adverse events. There are not enough data to recommend or discourage the use of beta-blockers in children with congestive heart failure. Further investigations are required to establish guidelines for therapy.