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No benefits from 'outdated' beta-blockers after heart attack
Swedish researchers have described as outdated the standard practice of prescribing beta-blockers after a heart attack to lessen the risk of a future cardiovascular attack or death, saying there is no significant benefit to this.In the REDUCE-AMI trial, the scientists randomly assigned participants to receive a beta-blocker after diagnosis of preserved ejection fraction following a heart attack, also called a myocardial infarction.The findings showed no significant difference in cardiovascular outcomes between the beta-blockers group and the no-beta-blockers group, reports
Medical News Today
.The trial abstract appeared in
The New England Journal of Medicine
.One measurement of heart health is ejection fraction – or how well the left ventricle of the heart pushes out blood. If the measurement is low, it can indicate heart failure.In the REDUCE-AMI trial, scientists wanted to find out if beta-blockers reduce the risk of death or another heart attack in people who had a heart attack but still had a normal ejection fraction.The trial began in September 2017 and ended in May 2023. During that time, the researchers recruited 5,020 people from 45 healthcare centres for the study.In addition to needing a normal heart ejection fraction, participants also had to have a coronary angiography during their hospital stay. The scientists randomly assigned which participants would take a beta-blocker (metoprolol or bisoprolol) as a long-term treatment and had a median follow-up of 3.5 years.They found that the beta-blockers provided no overall benefit to these participants, as any-cause death in the beta-blocker group was 3.9%, and death in the group that did not receive a beta-blocker was 4.1%.In the beta-blocker group, 7.9% of the participants experienced what the scientists classified as a 'primary outcome' of either death or a new heart attack.This is only slightly lower than the primary outcomes in the no-beta-blockers group, which was 8.3% of the participants either dying or having a new heart attack.The scientists do not consider this small difference to be statistically significant.After taking a closer look at the data, they found that beta-blocker treatment showed no significant benefit in preventing any-cause death, which was 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group.They also saw no improvement in the risk of death from cardiovascular causes or hospitalizations for atrial fibrillation (AFib) and heart failure in people who took beta-blockers.These findings challenge the conventional belief that beta-blockers are universally beneficial after a heart attack.Lead study investigator Tomas Jernberg, MD, PhD, a cardiology professor and HoD of Clinical Sciences at
Karolinska Institutet , said: 'I think the guidelines will be changed, and the prescription of beta-blockers will be reduced in patients with a heart attack (myocardial infarction) and a preserved (or normal) heart function – that is, about half of all patients with heart attack.'However, he said the study was conducted only in patients with normal heart function after a heart attack, and not in people with a reduced ejection fraction.Another limitation was that it was an open study versus placebo-controlled, but said this should not 'affect the primary outcome, death or new myocardial infarction'.'For patients with reduced heart function or heart failure, we know that beta-blockers improve survival and symptoms.'Will physicians continue to prescribe beta-blockers?Dr Cheng-Han Chen, board-certified interventional cardiologist and medical director of the Structural Heart Programme at
MemorialCare Saddleback Medical Centre
in Laguna Hills, California, said: 'This single study may not immediately change our long-standing practice regarding beta-blockers in patients with normal left ventricular function after myocardial infarction, but other similar trials are ongoing, which are examining this same question.'He said not prescribing beta-blockers to patients with normal heart function could reduce the stress of medication management.Beta-Blockers after Myocardial Infarction and Preserved Ejection FractionPublished in
The New England Journal of Medicine
on 7 April 2024AbstractBackgroundMost trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin–angiotensin–aldosterone system antagonists.MethodIn a parallel-group, open-label trial performed at 45 centres in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary endpoint was a composite of death from any cause or new myocardial infarction.ResultsFrom September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary endpoint event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no–beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P=0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary endpoints (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no–beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety endpoints, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no–beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%.ConclusionsAmong patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary endpoint of death from any cause or new myocardial infarction than no beta-blocker use.
#J-18808-Ljbffr
Swedish researchers have described as outdated the standard practice of prescribing beta-blockers after a heart attack to lessen the risk of a future cardiovascular attack or death, saying there is no significant benefit to this.In the REDUCE-AMI trial, the scientists randomly assigned participants to receive a beta-blocker after diagnosis of preserved ejection fraction following a heart attack, also called a myocardial infarction.The findings showed no significant difference in cardiovascular outcomes between the beta-blockers group and the no-beta-blockers group, reports
Medical News Today
.The trial abstract appeared in
The New England Journal of Medicine
.One measurement of heart health is ejection fraction – or how well the left ventricle of the heart pushes out blood. If the measurement is low, it can indicate heart failure.In the REDUCE-AMI trial, scientists wanted to find out if beta-blockers reduce the risk of death or another heart attack in people who had a heart attack but still had a normal ejection fraction.The trial began in September 2017 and ended in May 2023. During that time, the researchers recruited 5,020 people from 45 healthcare centres for the study.In addition to needing a normal heart ejection fraction, participants also had to have a coronary angiography during their hospital stay. The scientists randomly assigned which participants would take a beta-blocker (metoprolol or bisoprolol) as a long-term treatment and had a median follow-up of 3.5 years.They found that the beta-blockers provided no overall benefit to these participants, as any-cause death in the beta-blocker group was 3.9%, and death in the group that did not receive a beta-blocker was 4.1%.In the beta-blocker group, 7.9% of the participants experienced what the scientists classified as a 'primary outcome' of either death or a new heart attack.This is only slightly lower than the primary outcomes in the no-beta-blockers group, which was 8.3% of the participants either dying or having a new heart attack.The scientists do not consider this small difference to be statistically significant.After taking a closer look at the data, they found that beta-blocker treatment showed no significant benefit in preventing any-cause death, which was 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group.They also saw no improvement in the risk of death from cardiovascular causes or hospitalizations for atrial fibrillation (AFib) and heart failure in people who took beta-blockers.These findings challenge the conventional belief that beta-blockers are universally beneficial after a heart attack.Lead study investigator Tomas Jernberg, MD, PhD, a cardiology professor and HoD of Clinical Sciences at
Karolinska Institutet , said: 'I think the guidelines will be changed, and the prescription of beta-blockers will be reduced in patients with a heart attack (myocardial infarction) and a preserved (or normal) heart function – that is, about half of all patients with heart attack.'However, he said the study was conducted only in patients with normal heart function after a heart attack, and not in people with a reduced ejection fraction.Another limitation was that it was an open study versus placebo-controlled, but said this should not 'affect the primary outcome, death or new myocardial infarction'.'For patients with reduced heart function or heart failure, we know that beta-blockers improve survival and symptoms.'Will physicians continue to prescribe beta-blockers?Dr Cheng-Han Chen, board-certified interventional cardiologist and medical director of the Structural Heart Programme at
MemorialCare Saddleback Medical Centre
in Laguna Hills, California, said: 'This single study may not immediately change our long-standing practice regarding beta-blockers in patients with normal left ventricular function after myocardial infarction, but other similar trials are ongoing, which are examining this same question.'He said not prescribing beta-blockers to patients with normal heart function could reduce the stress of medication management.Beta-Blockers after Myocardial Infarction and Preserved Ejection FractionPublished in
The New England Journal of Medicine
on 7 April 2024AbstractBackgroundMost trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin–angiotensin–aldosterone system antagonists.MethodIn a parallel-group, open-label trial performed at 45 centres in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary endpoint was a composite of death from any cause or new myocardial infarction.ResultsFrom September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary endpoint event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no–beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P=0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary endpoints (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no–beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety endpoints, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no–beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%.ConclusionsAmong patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary endpoint of death from any cause or new myocardial infarction than no beta-blocker use.
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