Most people go on a beta-blocker after a heart attack.
However, a new study concludes the medication may not make a difference in terms of longevity for some survivors.
Heart attack patients with heart failure need beta-blockers to keep their hearts working after a cardiac event.
Oftentimes, people who do not have heart failure are put on the drugs, too. In fact, about 95 percent of those who’ve had heart attacks but don’t have heart failure are prescribed beta-blockers.
A beta-blocker is a type of medication that lowers blood pressure and heart activity. Side effects include tiredness and dizziness.
Researchers from the University of Leeds, in England, evaluated data from about 179,000 heart attack patients who did not have heart failure. Data came from the United Kingdom’s national heart attack registry.
The team found people without heart failure who took beta-blockers did not live longer after their heart attacks than those who didn’t take the drugs.
The authors say the drugs may be raising medical costs and being overprescribed. Their study was published in the Journal of the American College of Cardiology.
“If you look at the patients who had a heart attack but not heart failure, there was no difference in survival rates between those who had been prescribed beta-blockers and those that had not,” Dr. Marlous Hall, a senior epidemiologist at the Leeds Institute of Cardiovascular and Metabolic Medicine, said in a statement.
Dr. Martha Gulati, a cardiologist, and editor in chief of the American College of Cardiology’s CardioSmart website, noted that most heart attack survivors are put on beta-blockers for about three years.
Many times, though, they stay on the medication due to other medical reasons.
The most recent guidelines say nothing is wrong with keeping patients on beta-blockers for the long-term if there were no problems, Gulati told Healthline.
Dr. Michael Miller, a professor at the University of Maryland School of Medicine, told Healthline that older studies found that the medication reduced the risk for another heart attack or heart-related death by about 25 percent.
That’s why beta-blockers been routinely recommended after a heart attack.
The medical community has also known that the drugs were most effective when a major heart attack created significant heart damage, poor heart function, or heart failure.
In fact, a recent study found that there was no increased risk of death when beta-blockers were discontinued after a year of treatment so long as heart failure did not occur after the heart attack.
Similar to beta-blockers, ACE inhibitors are another type of medication that can decrease heart-related death after a heart attack.
Like beta-blockers, they are most effective if the heart attack results in heart failure or poor heart function, Miller noted.
“Importantly, evidence is lacking that beta-blockers are useful after a minor heart attack, when heart function is minimally affected,” Miller said.
He said the study reaffirms what was previously shown in smaller studies — heart attack survivors without heart failure or poor heart function won’t benefit from beta-blockers.
More research needed
The study does have its limits.
“The main limitation is that as an observational study it only derives associations,” Miller explained.
To prove cause-effect, a randomized controlled study would be needed. With that type of study, 50 percent of patients would receive a beta-blocker and 50 percent would receive a placebo.
Until that type of study is conducted, it’s unlikely that the United States will modify its recommendation.
Gulati agreed that the study should change care until a randomized controlled trial is conducted.
“It should look at the short-term and long-term effect so we can also determine how long to use the medication, if at all,” Gulati added.
In Miller’s practice, he tends to discontinue beta-blocker usage in heart attack survivors who have preserved heart function after the first year of treatment.
They are only kept on the medication if there is another reason that warrants it, such as hypertension.
Candidates who can benefit from beta-blockers include those with heart failure, abnormal heart rhythm, hypertension, and recurrent palpitations that occur without a known trigger (such as caffeine).
“The patient should always discuss with their physician whether or not a beta-blocker is a suitable treatment and/or should be discontinued,” he said.
If a patient is going to stop taking the medication, reduce the amount slowly instead of stopping abruptly.
Guidelines could change with more research
Gulati said she hopes the study makes the medical community “pause and reflect” on managing patients.
“Ultimately, we want to use drugs on the right people and not give medications that either have no benefit,” Gulati said. “It isn’t just about cost [because these are relatively cheap drugs] but no one wants to take a medication if it doesn’t improve outcomes.”
Currently, doctors tell patients that beta-blockers reduce recurrent events and prevent deaths.
“At this point, we try to start anyone after a heart attack on a beta-blocker,” Gulati added. “And like I said, this study won’t make me change that practice. It will just make me hope for the right trial to follow this very large observational trial to determine if the observation, was in fact, correct.”