Beta-Blockers not linked to Mortality Benefit for Heart Attack Survivors
Beta-blockers have been used to treat heart attack survivors for years. Now, two new studies are questioning whether or not beta-blockers provide any mortality benefit for these patients since new contemporary medical treatments, such as reperfusion, statins and antiplatelet agents have been introduced.
In the first study, the researchers examined 60 randomized trials that involved 102,003 patients. The team separated the trials into two time periods, which were before the reperfusion era and after. They analyzed the effects of being treated with contemporary therapy in combination with beta-blockers and concluded that beta-blockers did not lead to any mortality benefit for the survivors.
"In patients undergoing contemporary treatment, our data support the short-term (30 days) use of beta-blockers to reduce recurrent heart attacks and angina, but this has to be weighed at the expense of increase in heart failure, cardiogenic shock, and drug discontinuation, without prolonging life," lead investigator Sripal Bangalore, MD, MHA, of NYU Langone Medical Center, New York, said according to the press release. "The guidelines should reconsider the strength of recommendations for beta-blockers post myocardial infarction."
In the second study, the researchers set out to examine the relationship between patients' heart rate at discharge and their five-year mortality rate. They examined the discharge heart rate in more than 3,000 patients and concluded that a higher heart rate was tied to a greater risk of death.
"We found several factors related to a high heart rate. They included ST-elevation myocardial infarction, diabetes, chronic obstructive pulmonary disease, bleeding/transfusion during hospitalization, left ventricular dysfunction, renal dysfunction, and prescription of beta-blockers at discharge. Women were also more likely to have a high heart rate," senior investigator François Schiele, MD, PhD, Chief of Cardiology at the University Hospital Jean Minjoz, Besançon, France, said. "We found that the discharge heart rate is significantly related to one-year mortality, and that patients discharged with a high heart rate are at higher risk of death during the first year, irrespective of beta-blocker use."
The studies, "Clinical Outcomes with Beta-Blockers for Myocardial Infarction: A Meta-analysis of Randomized Trials" and "Discharge Heart Rate and Mortality after Acute Myocardial Infarction," were published in The American Journal of Medicine.