people already receiving - blockers Waagstein MDC Metoprolol Placebo (n=189) Symptomatic dilated cardiomyopathy and ejection fraction below aged 16-75 years people were required to have achieved a state of compensated heart failure by means of conventional heart failure treatment, which could include digitalis, diuretics, ACEI and nitrates. Systolic BP of 90 mm Hg and heart rate of 45 bpm treatment with -blockers , calcium channel blockers, inotropic agents (except digitalis), or high doses of tricyclic antidepressant drugs significant coronary artery disease shown by angiography ( > 50% obstruction of a major epicardial vessel) clinical or histological signs of ongoing myocarditis, other life threatening diseases chronic obstructive lung disease requiring 2-agonists excessive alcohol consumption (> 700 g per week) *Data could not be directly extracted for: CORPENICUS251 which could not be accessed and MERIT- . Treating Heart Failure Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Table 35: Clinical evidence summary: beta-blocker versus placebo Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with placebo Risk difference with beta-blockers (95% CI) All-cause mortality 2666 MODERATEb due to imprecision (from 22 fewer to 32 more) First heart-failure related hospital admission MODERATEa due to indirectness (from 32 fewer to 16 more) Fatal and non-fatal stroke at 3.3 years LOWb due to imprecision c c (a) Downgraded by 1 increment due to indirectness of the outcome which only reported first heart-failure related hospital admission rather than all-cause. (b) Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both. (c) Not estimable as only the summary statistic was reported by Kotecha 2014181 and no additional information regarding the event rates were available from the original papers. 