Beta Blockers May Not be Crucial for Post-Heart Attack Care

Prescribing beta blockers after a heart attack may be unnecessary.

After a heart attack, a majority of patients are prescribed beta blockers—an angiotensin-converting-enzyme (ACE) inhibitor—and statins to prevent recurrent heart attack and mortality. Patients are typically prescribed the drugs for the rest of their lives.

A new study published by the Journal of the American College of Cardiology suggests that beta blockers may be unnecessary after a heart attack if patients are adhering to statins and ACE inhibitors. These findings question current guidelines that patients require lifelong therapy with the 3 drugs.

In the study, the authors examined the benefits of using the 3 drugs. Included in the study were more than 90,000 Medicare beneficiaries who had been prescribed a beta blocker, an ACE inhibitor, or an angiotensin receptor blocker (ARB).

The authors found that patients who took the ACE inhibitor or an ARB and statin combination did not have an increased risk of death compared with patients who took all 3 drugs, according to the study.

For the first 6 months, the authors followed patients who filled their prescription for all 3 drugs to examine their level of medication adherence. They followed these patients for an additional 18 months to determine how many died.

At 6 months post heart attack, approximately 50% of patients stopped treatment with at least 1 drug, according to the study.

For patients who adhered to all 3 drugs, the 1-year mortality rate was 9.3%, compared with 9.1% for those who adhered to an ACE inhibitor or ARB, and statins but not beta blockers, according to the study. The authors report that these findings were not statistically significant.

Notably, among patients who were not adherent to any of the prescribed drugs, the 1-year mortality rate was 14.3%, a 54% increase over adherent patients.

“The problem with this 3-drug regimen is that it is difficult for people to take their medications as they are supposed to in the long term. This is especially true of older patients who are likely to already be taking many different drugs,” said lead researcher Gang Fang, PharmD, PhD.

The authors also found that patients who had diabetes, dementia, or both conditions had a higher mortality rate, even when they remained adherent to therapy, according to the study. The investigators urge physicians to be cautious when prescribing this regimen to patients with diabetes or dementia.

These results suggest that beta blockers may not necessarily improve mortality rates among heart attack survivors. Despite these findings, the authors do not advise patients to stop taking their prescribed treatments without consulting their physician, according to the study.

“We are not saying that beta blockers have no value,” Dr Fang concluded. “It’s just that their benefits appear to have been eclipsed by the duo of ACE inhibitors and statins, which are relatively newer drugs.”