Drug or drug therapy

Study Overview: The $\beta$-Blocker Evaluation of Survival Trial (BEST)

The BEST study was a multicenter, randomized, double-blind, placebo-controlled clinical trial designed to evaluate the effect of the beta-blocker bucindolol on survival in patients with advanced chronic heart failure (HF). Although the focus was on chronic HF, the findings have profound implications for post-MI care, as many patients develop HF following significant cardiac damage.

Design and Methodology

Study Population: The trial enrolled 2,708 patients (age $\geq 18$ years) across the United States, Canada, and Brazil.

Inclusion Criteria: Patients had established NYHA Class III or IV heart failure due. While HF etiology varied, a large subset had ischemic cardiomyopathy (HF caused by prior MI). Patients had to be on standard background therapy, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, and digitalis.

Intervention: Patients were randomly assigned in a 1:1 ratio to receive either:

Bucindolol: Titrated up to 200 mg/day.

Placebo: Matching inactive tablet.

Primary Endpoint: All-cause mortality.

Sample Answer

Beta-Blocker Therapy Post-Myocardial Infarction: The Critical Role of the $\beta$-Blocker Evaluation of Survival Trial (BEST)

The management of patients following an acute Myocardial Infarction (MI), or heart attack, is anchored by therapies proven to reduce mortality and morbidity. Among the most crucial are beta-blockers (BBs), a class of drugs that block the effects of epinephrine and norepinephrine on $\beta$-adrenergic receptors. While their benefit in the acute phase was established, large-scale studies were essential to confirm their long-term benefit and identify specific patient populations that benefit most. The $\beta$-Blocker Evaluation of Survival Trial (BEST) is one such pivotal study that solidified the role of BBs in chronic heart failure (HF) that often develops post-MI.