heart rate < 60 bpm or systolic blood pressure <90 mm Hg) current use of beta-blockers significant hepatic or renal dysfunction cerebrovascular accidents within the previous 3 months being on a waiting list for percutaneous coronary intervention or cardiac surgery or other major medical conditions that may have reduced survival during the period of the study , Joglar US-HF Carvedilol (n=696) Placebo (n=398) Multicentre with varying treatment protocols. Symptomatic heart failure for at least three months ejection fraction 35%, despite at least two months of treatment with diuretics and an ACE (if tolerated) A major cardiovascular event or a major surgical procedure within three months of entry into the study; uncorrected, primary valvular disease; active myocarditis; sustained ventricular tachycardia or advanced heart block not controlled by antiarrhythmic intervention or a pacemaker; systolic blood pressure of more than 160 or less than 85 mm Hg or diastolic blood pressure of more than 100 mm Hg; a heart rate of less than 68 beats per minute; clinically important hepatic or renal disease; or any condition other than heart failure that could limit exercise or survival. people receiving calcium- channel blockers, - or - adrenergic agonists or class IC Chronic Heart Failure Beta-blockers in heart failure and concomitant atrial fibrillation NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Study Intervention and comparison Inclusion criteria Exclusion criteria or III antiarrhythmic agents were not enrolled. 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. 