Which class of medications is known to improve survival significantly in patients with heart failure and reduced ejection fraction?

Beta-blockers are a class of medications that have been shown to significantly improve survival in patients with heart failure and reduced ejection fraction (HFrEF). This benefit is primarily attributed to their ability to decrease heart rate, improve cardiac output, and reduce myocardial oxygen demand. Beta-blockers also help to mitigate the neurohormonal activation that often exacerbates heart failure, particularly the adrenergic system's overactivity.

The clinical trials supporting the use of beta-blockers in HFrEF patients, such as the MERIT-HF and CARVEDILOL trials, have demonstrated that these medications reduce mortality and hospitalizations related to heart failure. They enhance the overall quality of life and functional capacity of patients with this condition.

In contrast, while calcium channel blockers can manage hypertension and control arrhythmias, they are not indicated for improving survival in heart failure. Loop diuretics are effective in relieving symptoms of fluid overload, and thiazide diuretics can assist in blood pressure management, but neither class addresses the underlying pathophysiology of heart failure nor shows a clear survival benefit in HFrEF.