The scientific consensus on beta blockers for heart failure prior to 1973

This post contains an email exchange I had with a medical scientist, in an attempt to resolve a debate about whether there was a "scientific consensus" prior to 1973 that beta blockers were contraindicated for heart failure. (There most certainly was!)

The medical scientist is Dr. Christian Funck-Brentano, author of Beta-blockade in CHF: from contraindication to indication: I wrote to Dr. Funck-Brentano:

Dear Dr. Funck-Brentano:

Would you say there was a scientific consensus that beta blockers were contraindicated for heart failure prior to 1973? If you think there was a scientific consensus prior to 1973 that beta blockers were contraindicated for heart failure, what was the scientific basis for that consensus?

With many thanks and deepest respect,
Mark Bahner

P.S. Is it all right if I share your reply with some people with whom I'm discussing the matter?

Dr. Funck-Brentano responded:

Dear Sir,

I cannot tell you exactly the date beta-blockers were officially contraindicated in patients with heart failure but, clearly, there was a scientific consensus that this was the case until the CIBIS II and MERIT-HF trials were published in 1999. Beta-blockers are negative inotropes (they decrease myocardial contractility) and their use in heart failure was justified by the deleterious effects of sympathetic activation in patients with heart failure. Only, they need to be slowly up-titrated.

Official indication followed the publications of these two landmark clinical trials, I think in 2000. Before CIBIS II and MERIT-HH were completed, Dr Karl Swedberg had reported individual cases and under-powered studies suggesting the benefit of beta-blockers in heart failure.

I attach an article I published on this history of moving from contraindication to indication. You are welcome to share this article as long as you comply with copyrights issues.

Best regards
Christian Funck-Brentano M.D., Ph.D., FESC
Professor of Medicine and Pharmacology
Sorbonne University - School of Medicine
Department of Pharmacology
Clinical Investigation Center Paris-Est
Hôpitaux Universitaires Pitié-Salpêtrière - Charles-Foix
47-83 Boulevard de l'Hôpital
75013 - Paris
FRANCE

I followed up with:

Dear Dr. Funck-Bretano,

Many thanks for your detailed response. Unfortunately, I have no medical degree or experience in medical research, so I want to make sure I'm not misunderstanding your reply.

I think you are saying that there was a scientific consensus that beta-blockers were contraindicated for heart failure all way up to 1999.

So am I correct in assuming that the scientific consensus would be even stronger--essentially 100 percent--that beta blockers were contraindicated for heart failure prior to 1973?

And the scientific consensus that they were contraindicated for heart failure would be due to their negative inotropic properties (and the adverse results reported in 1966, as described in the Introduction in your paper)?

Thank you so much,
Mark

Dr. Funck-Brentano replied:

Right

Christian Funck-Brentano
(Sent from a Smartphone with highly imperfect spell checking. Excuse my brevity)