Long Term Use of Beta-Blockers For Heart Risk

A comprehensive study published in the journal Heart reveals that the long-term use of beta blockers to reduce the risk of further heart attacks or death in individuals who do not have heart failure is not appropriate. The researchers discovered no difference in these risks between patients who used beta blockers more than a year after their heart attack and those who did not.

Beta-blockers are a type of medication that is commonly used to treat irregular cardiac rhythms, as well as angina and excessive blood pressure. They are regularly taken following a heart attack to reduce the chance of recurrence and other cardiovascular complications–a procedure known as secondary prevention.

However, it is unclear whether these drugs are necessary after the first year in patients who do not have heart failure or a potentially fatal complication of a heart attack known as left ventricular systolic dysfunction, or LVSD for short.

According to the researchers, the majority of current information is based on clinical trial outcomes that precede key changes in the regular care of heart attack patients.

To supplement the evidence, the researchers drew on 43,618 persons who had a heart attack that needed hospitalization between 2005 and 2016 and whose information had been recorded in the National Swedish Register for coronary heart disease (SWEDEHEART).

None of these individuals experienced heart failure or LVSD: 34,253 were prescribed beta blockers and were still taking them a year after hospital release; 9365 were not. Their average age was 64, and one in every four were female.

The researchers wanted to see if there were any changes in fatalities from any cause and rates of subsequent heart attacks, revascularisation (a technique to restore blood flow to portions of the heart), or hospital admission for heart failure between the two groups.

Long-term medication with beta-blockers was not related to improved cardiovascular outcomes throughout an average follow-up period of 4.5 years, according to real-time data.
Some 6475 (19%) of those on beta blockers died from any cause, while 2028 (22%) died from another heart attack, required unscheduled revascularisation, or were admitted to hospital for heart failure.
There was no detectable difference in the incidence of these occurrences between the two groups after accounting for potentially important factors such as demography and pertinent co-existing conditions.
Because this is an observational study, it cannot establish cause. Researchers recognize that, although being the largest study of its sort to date, the findings should be interpreted in the light of certain limitations.

Patients were not randomly assigned to treatment; only some cardiovascular outcomes were included; no indication of how regularly patients took their medications was provided; and no information on their health-related quality of life was provided.

There were also some variations between the two groups in terms of risk factors for poor cardiovascular outcomes.

However, beta-blockers are associated with a number of side effects, including depression and fatigue, and the researchers believe it is now time to reconsider the value of long-term treatment with these drugs in heart attack patients who do not have heart failure or LVSD.

In a linked editorial, Professor Ralph Stewart and Dr. Tom Evans, of Green Lane Cardiovascular Services, Auckland, New Zealand (Aotearoa), state: “Despite strong evidence that long-term beta-blockers can improve outcomes after [heart attack], it has been uncertain whether this benefit applies to lower risk patients who are taking other evidence-based therapies and who have a [normal functioning heart].”

They point out:”Recommendations on the duration of beta blocker therapy are variable or absent because this question was not specifically evaluated in clinical trials. Most patients take daily medications for many years after a [heart attack] because they believe they are beneficial.”

And they conclude: “[This] study raises an important question directly relevant to the quality of care—do patients with a normal [functioning heart] benefit from long term beta-blocker therapy after [heart attack]? To answer this question, more evidence from large randomized clinical trials is needed.”

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