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Beta blockers and mortality after myocardial infarction in patients without heart failure

Assessing the association between early treatment with beta blockers and mortality rates.
Beta Blockers

Assessing the association between early treatment with beta blockers and mortality rates

The benefit of beta blockers is undisputed in patients with heart failure. However, most trials assessing their benefits after acute myocardial infarction were carried out decades ago when reperfusion therapy was not used and secondary prevention drugs such as statins were not available.

There is some debate about the usefulness of prolonged beta blocker treatment after myocardial infarction and this has led to a divergence between American and European guidelines. Most patients with acute myocardial infarction continue their treatment with beta blockers for years after the acute episode.

The most recent meta-analysis found that beta blockers reduced mortality in the era before reperfusion but that this is no longer the case with todays more sophisticated interventions.

...

Assessing the association between early treatment with beta blockers and mortality rates

The benefit of beta blockers is undisputed in patients with heart failure. However, most trials assessing their benefits after acute myocardial infarction were carried out decades ago when reperfusion therapy was not used and secondary prevention drugs such as statins were not available.

Beta blockers
Prolonged beta blocker treatment after MI is unlikely to improve survival. Picture: iStock

There is some debate about the usefulness of prolonged beta blocker treatment after myocardial infarction and this has led to a divergence between American and European guidelines. Most patients with acute myocardial infarction continue their treatment with beta blockers for years after the acute episode.

The most recent meta-analysis found that beta blockers reduced mortality in the era before reperfusion but that this is no longer the case with today’s more sophisticated interventions.

Assessing the association

The purpose of this study was to assess the association between early and prolonged beta blocker treatment and mortality after acute myocardial infarction.

Researchers assessed the relationship between beta blocker use and mortality at three time points: early use (within 48 hours of admission) in relation to 30-day mortality; prescription of beta blockers at discharge in relation to one-year mortality; and use of beta blockers at one year in relation to five-year mortality.

Analysis showed a decrease over time in the association of beta blocker treatment with survival in acute myocardial infarction patients without heart failure or left ventricular dysfunction.

Early use of beta blockers at the acute stage of myocardial infarction seemed to be associated with a substantial decrease in 30-day mortality but prolonged beta blocker treatment beyond one year is unlikely to improve survival.


Puymirat E, Riant E, Aissoui N et al (2016) Beta blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study. BMJ. 354:i4801. 

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