- Beta-blockers are used to treat heart problems and high blood pressure and are commonly prescribed to people following a heart attack.
- In a new study, researchers say long-term use of the medications following a heart attack doesn’t appear to improve cardiovascular health.
- Experts say the observational study provides valuable information, but they note that beta-blockers are still beneficial for many people.
Researchers used the Swedish national register for coronary heart disease to examine the medical records of people who had a heart attack between 2005 and 2016 and required hospital treatment.
The study included records from 43,618 adults, with an average age of 64. About one-fourth were women. None had heart failure or left ventricular systolic dysfunction.
Of the participants, 34,253 (78%) were receiving beta-blockers and 9,365 (22%) weren’t receiving beta-blockers one year after hospitalization for a heart attack.
The scientists monitored the participants 1 year after hospitalization for an average of 4.5 years.
Researchers compared the two groups for:
· Rates of death from any cause
· Further heart attacks
· Receiving re-vascularization, a procedure to restore blood flow to parts of the heart
· Heart failure
During the monitoring period, 6,475 (19%) of those on beta-blockers and 2,028 (22%) experienced one of these events.
After accounting for demographics and relevant co-morbid conditions, the researchers reported there was no discernible difference in the rates between the two groups.
The researchers concluded that real-time data showed long-term beta-blocker use was not associated with improved cardiovascular outcomes following a heart attack in people without heart failure or left ventricular systolic dysfunction.
“Patients with left ventricle dysfunction should definitely be on beta blockers as there are clear mortality benefits,” said Dr. Hoang Nguyen, an interventional cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in California.
“In this patient population, beta blockers are lifelong,” he told Medical News Today. “In patients with a history of coronary artery disease who are not candidates for bypass surgery or stents, beta blockers are essential to reduce symptoms of angina (chest pain) and hospitalizations for this symptom. But, if they have been re-vascularized (either by stents or bypass surgery) or have normal left ventricle function, I may attempt to wean off beta blockers, especially if they have significant side effects.”
Some doctors are not ready to change their approach based on this study, at least not yet.
“This study suggests that in patients without any of those factors and with normal cardiac function, a long-term continuation of beta-blockers following myocardial infarction may not be of significant benefit,” said Dr. Devin Kehl, a non-invasive cardiologist at Providence Saint John’s Health Center in California. “However, this study was observational and is vulnerable to unrecognized confounders, which could have affected the findings.”
“Caution is needed in interpreting the results of this type of analysis and applying this clinical practice, and randomized trials are needed to be more certain about whether beta-blockers should be continued or discontinued beyond one-year post myocardial infarction,” Kehl told Medical News Today. “So, in summary, the case remains that careful clinical judgment by a patient’s cardiologist is essential in determining the duration of beta-blocker therapy following myocardial infarction.”
Beta-blockers treat heart problems and high blood pressure.
They do this by blocking the harmful effects of stress hormones on your heart and can decrease your heart rate. They can also help with migraine headaches.
Beta-blockers are generally considered safe and effective. However, there are a few side effects, which include:
“If a beta blocker is not needed after one year, especially if the patient’s heart function is normal, perhaps we should attempt to wean patients off beta blockers,” Nguyen said.
The side effects could prevent some people from taking them or cause people to stop taking them.
Medical professionals do not consider observational studies as robust as a randomized, controlled study. However, they offer valuable information for doctors and other medical professionals when prescribing medications.
“Beta-blockers have long been and will continue to remain a cornerstone medical therapy following a myocardial infarction as they have been clearly demonstrated to reduce the risk of recurrent events and death,” Kehl said. “However, clinical trials have not addressed the benefit of beta-blockers in patients with normal cardiac function beyond three years following a myocardial infarction, and their benefit is strongest in the early period post-myocardial infarction.”
“Furthermore, clinical trials addressing the benefit of beta-blockers have included a mixed cohort of patients with and without cardiac dysfunction,” he added. “The benefit of long-term continuation of beta-blockers following myocardial infarction in patients with normal cardiac function is uncertain. The American College of Cardiology guidelines do not specifically address this due to insufficient data from clinical studies. At present, a long-term continuation of beta-blocker relies on careful consideration of the patient’s cardiac history and whether there may be any other clear indications for using beta-blockers, such as arrhythmias, angina, cardiac dysfunction, heart failure, or hypertension.”