Beta blockers may provide no clinical benefit to patients who maintain normal heart function following a heart attack, according to a study published Aug. 30 in The New England Journal of Medicine.
The study’s findings are based on data from 8,505 patients across 109 hospitals in Spain and Italy who were followed for a median of about four years.
Beta blockers have been part of standard treatment after heart attack for more than 40 years, but can cause side effects such as fatigue, low heart rate and sexual dysfunction, according to a Sept. 2 news release from New York City-based Mount Sinai.
Another study, published simultaneously in the European Heart Journal, found that women treated with beta blockers had a higher risk of death, heart attack and hospitalization for heart failure compared to those not treated with the drug.
The studies were led by Valentin Fuster, MD, PhD, president of New York City-based Mount Sinai Fuster Heart Hospital. Dr. Fuster spoke to Becker’s about what the findings could mean for care guidelines in the U.S.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What was the impetus for the study?
Dr. Valentin Fuster: For the last few years, I personally haven’t used beta blockers in heart attack patients who had good function of the heart. Treatments have evolved over the last 30 years. The guidelines suggesting the use of beta blockers were from times when we didn’t have procedures to, for example, open arteries, which helps heart attack patients have better function of the heart.
Of heart attack patients today, I would say certainly over 50% have a normal function of the heart, or as we call it, normal ejection fraction. So for the past few years, with the advancements in the approach to heart attack care, I haven’t used beta blockers. But it was always questioned by my colleagues saying, “But the guidelines suggested it.”
Finally, Borje Ibanez, MD, PhD, and I decided to launch this trial. [Dr. Fuster is the general director and Dr. Ibanez is the scientific director of Spain’s Centro Nacional de Investigaciones Cardiovasculares.]
This trial, basically the largest in the field, looked at patients who not only had normal function of the heart following a heart attack — that is, an ejection fraction of 50% or more — but also a small group who had an ejection fraction between 40% to 49%. The results were obvious to us — there was no difference whatsoever in giving beta blockers to patients with an ejection fraction of 50% or more.
Q: Do these findings have the potential to change care or treatment guidelines for physicians in the U.S.?
VF: We put our trial data together with studies from Denmark and Finland and found that for ejection fractions between 40 and 49%, beta blockers might still be necessary. But the strength of our results among patients with 50% and over was very striking.
My take is the following: Patients with ejection fractions of 50% or over following a heart attack should not take beta blockers. Patients between 40–49%, they might have to take beta blockers.
We are going to do a meta-analysis now of all the different groups, which will be available in two or three months, but my suggestion today is: no beta blockers for 50% or higher ejection fraction, particularly in the Spanish community. The meta-analysis will be helpful to see how these findings apply to other communities, such as the U.S.
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