Sympathetic Overdrive and Role of Beta-blockers in Various Forms of Heart Failure: A Consensus Statement from India

H K Chopra¹, G S Wander², Tiny Nair³, C K Ponde⁴, Navin C Nanda⁵, Jagat Narula⁶, Saumitra Ray⁷, K Venugopal⁸, S S Iyengar⁹, R R Kasliwal¹⁰, Praveen Chandra¹¹, Sunil Prakash¹², Sandeep Bansal¹³, D S Rana¹⁴, Prafulla Kerkar¹⁵, Arup Dasbiswas¹⁶, J P S Sawhney¹⁷, S Shanmungasundram¹⁸, Viveka Kumar¹⁹, I B Vijayalakshmi²⁰, A K Pancholia²¹, Vinod Sharma²², Aditya Kapoor²³, H S Isser²⁴, Vishal Rastogi²⁵, Y K Arora²⁶, Ashok K Omar²⁷, Sunil Sathe²⁸, Rajeeve Rajput²⁹, D Prabhakar³⁰, G Justin Paul³¹, Priya Jagia³², Poonam Malhotra³³, G Suryaprakash³⁴, Vinod Mittal³⁵, Manish Jagia³⁶, A Jabir³⁷, S S Mishra³⁸, S N Routray³⁹, Ajay Kumar Sinha⁴⁰, Mohan Bhargava⁴¹, Kiran Mahmood⁴², Mona Bhatia⁴³, Pramila Kalra⁴⁴, V K Katyal⁴⁵, Rohit Tandon⁴⁶, Rahul Grover⁴⁷, Abhinav Chhabra⁴⁸, N R Shastry⁴⁹

Affiliations

¹ Senior Consultant, Department of Cardiology, Medanta Moolchand Heart Center, New Delhi, India.
² Professor and Head, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India, Corresponding Author.
³ Head, Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India.
⁴ Consultant Cardiologist and Head, Department of Cardiology, P D Hinduja National Hospital, Mumbai, Maharashtra, India.
⁵ Department of Cardiology Division, University of Alabama at Birmingham, Birmingham, Alabama.
⁶ Associate Dean, Icahn School of Medicine at Mount Sinai; Chief, Division of Cardiology, Mount Sinai Hospital, New York, United States of America.
⁷ Director, Invasive Cardiology, AMRI Hospital, Kolkata, West Bengal, India.
⁸ Senior Consultant Cardiologist, KVM Hospital Cherthala; SP Fort Hospital, Thiruvananthapuram, Kerala, India.
⁹ Consultant Emeritus and Academic Head, Department of Cardiology, Manipal Hospital, Bangalore, Karnataka, India.
¹⁰ Chairman, Clinical and Preventive Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.
¹¹ Chairman, Interventional and Structural Heart Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.
¹² Senior Director and Head, Department of Nephrology and Renal Transplantation, BLK-Max Super Speciality Hospital, New Delhi, India.
¹³ Consultant in Cardiology, Professor and Head, Department of Cardiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
¹⁴ Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi, India.
¹⁵ Senior Consultant Interventional Cardiologist, Asian Heart Institute, Mumbai, Maharashtra, India.
¹⁶ Ex Director, Professor and Head of Department of Cardiology, ICVS, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
¹⁷ Chief of Clinical and Preventive Cardiology; Chairman of Department of Cardiology, Sir Gangaram Hospital, Delhi, India.
¹⁸ Senior Cardiologist, Billroth Hospitals, Chennai, India.
¹⁹ Principal Director and Chief of Cath Labs (Pan Max), Cardiac Sciences, Max Hospital, New Delhi, India.
²⁰ Professor Emeritus, Former Head of Pediatric Cardiology, Shri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
²¹ Head of Department, Department of Clinical and Preventive Cardiology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India.
²² Head of Cardiology and Vice Chief Executive Officer, National Heart Institute, New Delhi, India.
²³ Head, Department of Cardiology, SGPGI Hospital, Lucknow, Uttar Pradesh, India.
²⁴ Professor and Consultant, Department of Cardiology, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India.
²⁵ Director, Department of Interventional Cardiology, Head of Advanced Heart Failure Program, Fortis Escort Heart Institute, Okhla Road, New Delhi, India.
²⁶ Consultant Cardiologist, National Heart Institute, New Delhi, India.
²⁷ Director-Non-Invasive Cardiology, Head of Heart Command Centers, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India.
²⁸ Interventional Cardiologist, Ruby Hall Clinic, Pune, Maharashtra, India.
²⁹ Senior Consultant Cardiologist, Apollo Hospitals, New Delhi, India.
³⁰ Consultant Interventional Cardiologist, Ashwin Clinic, Chennai, India.
³¹ Professor of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India.
³² Professor and Head, Department of Cardiovascular Imaging and Endovascular Interventions, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Delhi, India.
³³ Senior Professor, Department of Cardiac Anesthesia, All India Institute of Medical Sciences, Delhi, India.
³⁴ Senior Consultant Cardiologist and Clinical Director, Care Hospitals, Hyderabad, Telangana, India.
³⁵ Senior Consultant Diabetologist and Head, Centre for Diabetes and Metabolic Diseases, Delhi Heart and Lung Institute, Delhi, India.
³⁶ Director, Department of Anesthesia and Critical Care, Moolchand Hospital, New Delhi, India.
³⁷ Senior Cardiologist and Assistant Professor, Lisie Hospital, Cochin, Kerala, India.
³⁸ Director and Senior Consultant Cardiologist, Med N Heart Clinic, Cuttack, India.
³⁹ Professor and Head, Department of Cardiology, SCB Medical College, Cuttack, India.
⁴⁰ Senior Consultant, Department of Cardiology, Medanta Heart Institute, Patna, Bihar, India.
⁴¹ Director of Cardiology and Interventional Cardiologist, Max Hospital, Saket, Delhi, India.
⁴² Assistant Professor of Medicine (Cardiology), Icahn School of Medicine, Mount Sinai; Director of Heart Failure Program, Mount Sinai Morningside Hospital, New York, USA.
⁴³ Principal Director and Head, Department of Radiology and Imaging, Fortis Escort Heart Institute, New Delhi, India.
⁴⁴ Professor and Head, Department of Endocrinology, Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India.
⁴⁵ Head of Department, Department of Medicine, Positron Multispecialty and Cancer Hospital, Rohtak, India.
⁴⁶ Consultant, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
⁴⁷ Associate Director, Nephrology, Max Hospital, Saket, New Delhi, India.
⁴⁸ Consultant Interventional Cardiologist, Medanta Hospital, Gurugram, Haryana, India.
⁴⁹ Consultant Cardiologist, Medanta Moolchand Heart Center, New Delhi, India.

PMID: 39563129
DOI: 10.59556/japi.72.0740

Sympathetic Overdrive and Role of Beta-blockers in Various Forms of Heart Failure: A Consensus Statement from India

H K Chopra et al. J Assoc Physicians India. 2024 Nov.

. 2024 Nov;72(11):e32-e39.

doi: 10.59556/japi.72.0740.

Authors

Affiliations

¹ Senior Consultant, Department of Cardiology, Medanta Moolchand Heart Center, New Delhi, India.
² Professor and Head, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India, Corresponding Author.
³ Head, Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India.
⁴ Consultant Cardiologist and Head, Department of Cardiology, P D Hinduja National Hospital, Mumbai, Maharashtra, India.
⁵ Department of Cardiology Division, University of Alabama at Birmingham, Birmingham, Alabama.
⁶ Associate Dean, Icahn School of Medicine at Mount Sinai; Chief, Division of Cardiology, Mount Sinai Hospital, New York, United States of America.
⁷ Director, Invasive Cardiology, AMRI Hospital, Kolkata, West Bengal, India.
⁸ Senior Consultant Cardiologist, KVM Hospital Cherthala; SP Fort Hospital, Thiruvananthapuram, Kerala, India.
⁹ Consultant Emeritus and Academic Head, Department of Cardiology, Manipal Hospital, Bangalore, Karnataka, India.
¹⁰ Chairman, Clinical and Preventive Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.
¹¹ Chairman, Interventional and Structural Heart Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.
¹² Senior Director and Head, Department of Nephrology and Renal Transplantation, BLK-Max Super Speciality Hospital, New Delhi, India.
¹³ Consultant in Cardiology, Professor and Head, Department of Cardiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
¹⁴ Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi, India.
¹⁵ Senior Consultant Interventional Cardiologist, Asian Heart Institute, Mumbai, Maharashtra, India.
¹⁶ Ex Director, Professor and Head of Department of Cardiology, ICVS, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
¹⁷ Chief of Clinical and Preventive Cardiology; Chairman of Department of Cardiology, Sir Gangaram Hospital, Delhi, India.
¹⁸ Senior Cardiologist, Billroth Hospitals, Chennai, India.
¹⁹ Principal Director and Chief of Cath Labs (Pan Max), Cardiac Sciences, Max Hospital, New Delhi, India.
²⁰ Professor Emeritus, Former Head of Pediatric Cardiology, Shri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
²¹ Head of Department, Department of Clinical and Preventive Cardiology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India.
²² Head of Cardiology and Vice Chief Executive Officer, National Heart Institute, New Delhi, India.
²³ Head, Department of Cardiology, SGPGI Hospital, Lucknow, Uttar Pradesh, India.
²⁴ Professor and Consultant, Department of Cardiology, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India.
²⁵ Director, Department of Interventional Cardiology, Head of Advanced Heart Failure Program, Fortis Escort Heart Institute, Okhla Road, New Delhi, India.
²⁶ Consultant Cardiologist, National Heart Institute, New Delhi, India.
²⁷ Director-Non-Invasive Cardiology, Head of Heart Command Centers, Fortis Escorts Heart Institute, Okhla Road, New Delhi, India.
²⁸ Interventional Cardiologist, Ruby Hall Clinic, Pune, Maharashtra, India.
²⁹ Senior Consultant Cardiologist, Apollo Hospitals, New Delhi, India.
³⁰ Consultant Interventional Cardiologist, Ashwin Clinic, Chennai, India.
³¹ Professor of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India.
³² Professor and Head, Department of Cardiovascular Imaging and Endovascular Interventions, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Delhi, India.
³³ Senior Professor, Department of Cardiac Anesthesia, All India Institute of Medical Sciences, Delhi, India.
³⁴ Senior Consultant Cardiologist and Clinical Director, Care Hospitals, Hyderabad, Telangana, India.
³⁵ Senior Consultant Diabetologist and Head, Centre for Diabetes and Metabolic Diseases, Delhi Heart and Lung Institute, Delhi, India.
³⁶ Director, Department of Anesthesia and Critical Care, Moolchand Hospital, New Delhi, India.
³⁷ Senior Cardiologist and Assistant Professor, Lisie Hospital, Cochin, Kerala, India.
³⁸ Director and Senior Consultant Cardiologist, Med N Heart Clinic, Cuttack, India.
³⁹ Professor and Head, Department of Cardiology, SCB Medical College, Cuttack, India.
⁴⁰ Senior Consultant, Department of Cardiology, Medanta Heart Institute, Patna, Bihar, India.
⁴¹ Director of Cardiology and Interventional Cardiologist, Max Hospital, Saket, Delhi, India.
⁴² Assistant Professor of Medicine (Cardiology), Icahn School of Medicine, Mount Sinai; Director of Heart Failure Program, Mount Sinai Morningside Hospital, New York, USA.
⁴³ Principal Director and Head, Department of Radiology and Imaging, Fortis Escort Heart Institute, New Delhi, India.
⁴⁴ Professor and Head, Department of Endocrinology, Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India.
⁴⁵ Head of Department, Department of Medicine, Positron Multispecialty and Cancer Hospital, Rohtak, India.
⁴⁶ Consultant, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
⁴⁷ Associate Director, Nephrology, Max Hospital, Saket, New Delhi, India.
⁴⁸ Consultant Interventional Cardiologist, Medanta Hospital, Gurugram, Haryana, India.
⁴⁹ Consultant Cardiologist, Medanta Moolchand Heart Center, New Delhi, India.

PMID: 39563129
DOI: 10.59556/japi.72.0740

Abstract

In heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival. The aim of this consensus paper is to identify patient profiles, initiation or up-titration of beta-blockers and benefits of chirally pure beta-blocker in patients with heart failure. This expert consensus will ensure precise implementation of beta-blockers in heart failure as a part of guideline-directed medical therapy.

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Sympathetic Overdrive and Role of Beta-blockers in Various Forms of Heart Failure: A Consensus Statement from India

Affiliations

Sympathetic Overdrive and Role of Beta-blockers in Various Forms of Heart Failure: A Consensus Statement from India

Authors

Affiliations

Abstract

MeSH terms

Substances

LinkOut - more resources

Medical