New research casts doubt on some benefits of beta-blockers
For over four decades, many heart attack survivors have been sent home with a prescription for beta-blockers, which are drugs that impact the effects of hormones and adrenaline on the heart and blood vessels.
Now, new research is casting doubt on that practice and could change the standard of care around the world. The new study involved more than 8,000 patients and revealed that beta-blockers may offer no clinical benefit for patients with uncomplicated heart attack and preserved heart function. Researchers say this could alter international care guidelines to shift away from a one-size-fits-all approach.
The research was led by doctors at Mount Sinai Fuster Heart Hospital and the general director of Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC). The study focused on 8,500 patients at more than 100 hospitals in Spain and Italy and randomly assigned the heart attack survivors beta-blockers to some. The other patients did not take them. After four years, researchers found no significant difference in death rates between the two groups and no difference in recurrent heart attacks or heart failure hospitalizations. The study also showed that women treated with beta-blockers had a more than two-and-a-half percent higher risk of death compared to those not taking them.
Dr. Amish Mehta, Director of Noninvasive Cardiology at AHN Jefferson Hospital, says the primary takeaway is that for some patients, beta-blockers may not offer the significant clinical benefit that has been a standard assumption for the past 40 years.
“This challenges the long-standing practice of routinely prescribing beta-blockers to a large number of post-heart attack patients,” he says. “This suggests a need for a more nuanced and individualized approach. The research also highlights a notable finding: women in the subgroup analysis treated with beta-blockers had a higher risk of adverse events, including death, heart attack, or hospitalization for heart failure, particularly those with complete normal cardiac function post-heart attack. This is a critical point that demands further investigation and careful consideration when prescribing beta-blockers post cardiac event.”
Asked whether this will change how he treats his own patients or how he approaches prescribing beta-blockers for some, Mehta said, “While this research is groundbreaking and certainly prompts a reevaluation, it’s still too early to completely overhaul our standard of care based solely on this one study, particularly given the historical context and benefits for certain patient populations.”=
“However, this study further solidifies my approach in certain circumstances based on previous smaller studies, especially for patients with uncomplicated heart attacks and preserved ejection fractions. I will continue to be prudent with the duration of treatment and critically assess the necessity of initiating or continuing beta-blocker therapy in these specific cases.”
Mehta adds that for patients with even mild damage from complicated heart attacks and reduced heart function, the consensus remains that beta-blockers continue to be beneficial and are an important part of their treatment.
As for the differing results between men and women in the study, those warrant a closer look. “The differing results in women are indeed striking and raise several important questions,” says Mehta. “It’s plausible that beta-blockers could act differently in women due to physiological differences, hormonal influences, or variations in drug metabolism. It’s also well-established that underlying causes and presentations of heart disease and heart attack can differ between men and women.”
Women may experience different symptoms, have different types of coronary artery disease, or respond differently to stress. These factors could impact the efficacy and safety profile of beta-blockers.
For patients currently taking beta-blockers after a heart attack, Mehta’s immediate advice is NOT to stop taking their medication cold turkey.
“At their next appointment, patients can discuss the issue with their cardiologist,” he said. “We need to assess their specific type of heart attack, current heart function (ejection fraction), and any other comorbidities or indications for beta-blocker use. Going forward, I anticipate doctors will adopt a more personalized approach.”
He anticipates that for patients with uncomplicated heart attacks and preserved heart function, doctors will likely start a discussion about the potential for discontinuing beta-blockers if there are no other compelling reasons for their use.
“However, for patients with reduced ejection fraction (heart function) or other indications where beta-blockers have a proven benefit, they will continue to be a cornerstone of therapy,” Mehta said. “This research primarily targets the ‘uncomplicated’ patient group who has received rapid treatment for their heart attack.”
Beta-blockers are used for a host of cardiac reasons including treatment of weakened hearts, irregular heartbeats including atrial fibrillation, as well as hypertension. He warns they should not be stopped suddenly without a doctor’s advice.
Mehta also stresses one key phrase when it comes to heart attacks: Time is muscle. “What this means is that it is very important to seek medical attention immediately if you have any type of chest discomfort or sudden shortness of breath, or other concerning symptoms for a heart problem,” he said. “The sooner a diagnosis is made, and the sooner a heart attack is treated if that is the problem, the better a patient does.”