This site is intended for Healthcare professionals only.

Do All Patients Need β-Blockers After a Heart Attack?


Do All Patients Need β-Blockers After a Heart Attack?

Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction(AMI).Two large observational studies published last year in the Journal of the American College of Cardiology (JACC) have raised questions about the rationale of use of β-blockers in all patients after a first heart attack. Dr. Jennifer Abbasi in an article published online in  JAMA. has outlined very vividly various aspects of using of beta blockers in MI.

Salient Points-

  1. β-Blockers were approved in the 1980s for use in patients recovering from myocardial infarction (MI) after 2 large RCTs—the β-Blocker Heart Attack Trial (BHAT) and the Norwegian Multicenter Study Group trial—conclusively demonstrated that the agents reduced the risk of a second heart attack and death.
  2. 1999 review of 31 long-term RCTs confirmed their life-saving value after a heart attack.
  3. Multiple large trials have since confirmed the drugs’ benefit in people with heart failure. But β-blockers have not been tested in a large, contemporary trial involving people who had a heart attack but don’t have heart failure.
  4. In 2011 Update American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF) recommend that, barring contraindications, all patients should receive β-blockers after a heart attack to prevent a second one and continue taking them for at least 3 years.
  5. In the  Poststatin Era Jennifer G. Robinson found that β-blockers may not be needed as long as patients take both statins and ACE inhibitors or ARBs, and as long as there aren’t other indications, such as heart failure or arrhythmia.The studies have shown that as it is the patients who are on 3 drugs in most of cases  don’t take all three.
  6. In 2015 meta-analysis it was found that β-blockers certainly benefit in people with heart failure.In patients with PCI after MI β-blocker use was associated with a reduced risk of death only in certain patients, including those with reduced ejection fraction—a form of heart failure—or low use of other prophylactic drugs.
  7. Gale and a team of European researchers found no survival benefit of β-blockers at any time point up to 1 year after hospitalization for patients who had a heart attack but did not have heart failure or left ventricular systolic dysfunction (LVSD).
  8. β-blocker use was associated with lower 30-day mortality but not lower 5-year mortality, suggesting that long-term use may not save lives.
  9. Unlike the US guidelines, European guidelines don’t recommend β-blockers as a first-line prophylactic therapy for MI for all patients.
  10. Experts are of the opinion that it is Time for Trials and future studies are needed to settle the issue.

Although many experts  are in favour of continuing with the practice of prescribing beta blockers and feel that they still play an important role in the management of survivors of acute myocardial infarction.But all are of the opinion that it is Time for Trials and answers could come from Sweden’s national cardiac registry. In the REDUCE-SWEDEHEART trial, researchers are randomizing 7000 adults with normal left ventricular ejection fraction who are 1 to 7 days post-MI to either long-term β-blockers or no β-blockers. Registry data will be used to determine if β-blockers reduce new MIs and all-cause death over an estimated 1- to 3-year follow-up period. The results should be published around 2020, according to the researchers.

The carry home points are-

  • β-blockers certainly benefit in people after a heart attack with heart failure or left ventricular systolic dysfunction.
  • β-blocker use was associated with lower 30-day mortality but not lower 5-year mortality, suggesting that long-term use may not save lives.

For further reference log on to :

JAMA. Published online February 14, 2018. doi:10.1001/jama.2018.0107

The following two tabs change content below.
Dr. Kamal Kant Kohli

Dr. Kamal Kant Kohli

A Medical practitioner with a flair for writing medical articles, Dr Kamal Kant Kohli joined Medical Dialogues as an Editor-in-Chief for the Speciality Medical Dialogues. Before Joining Medical Dialogues, he has served as the Hony. Secretary of the Delhi Medical Association as well as the chairman of Anti-Quackery Committee in Delhi and worked with other Medical Councils of India. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751
Source: self

Share your Opinion Disclaimer

Sort by: Newest | Oldest | Most Voted
  1. In any case association of MI /CCF with Heart Block , Specifically LBB is an absolute contraindication for BETA- blockers .