Beta blockers may not improve survival after heart attack

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ACE inhibitors, beta blockers and statins
Results of the adherence study found similar survival rates for patients taking a combination of ACE inhibitors, statins and beta blockers, as well as ACE inhibitors and statins alone.

A new study has found that beta blockers are not needed after a heart attack if survivors are taking ACE inhibitors and statins. The study is the first to challenge the current clinical guideline that heart-attack survivors should take all three drugs—beta blockers, ACE inhibitors and statins—for the rest of their lives.

Heart-attack survivors are usually prescribed all three drugs to help prevent a second attack and death. However, the beta blockers offer no additional benefit for patients who take the other two drugs as prescribed, according to the new study which examined the trade-offs and consequences of using some of the medicines instead of others. The findings were published in the Journal of the American College of Cardiology.

Researchers looked at more than 90,000 Medicare patients age 65 or older who had suffered a heart attack and were prescribed a beta blocker, ACE inhibitor (or an angiotensin receptor blocker) and statin as preventive therapies after hospital discharge. Patients who only took the ACE inhibitor or an angiotensin receptor blocker and statin as prescribed were no more likely to die than those who took all three drugs.

“We found that patients who didn’t take their beta blockers but did take their ACE inhibitors and statins as prescribed were no more likely to die than patients who took all three drugs as prescribed in long term,” co-author Gang Fang (University of North Carolina, Chapel Hill, USA) says. “Physicians should emphasise to patients the importance of taking ACE inhibitors and statins.”

Fang stressed that patients should not stop taking beta blockers or any other prescription medicine without first consulting their physician.

Beta blockers “eclipsed” by combination of ACE inhibitors and statins

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

Researchers followed heart-attack survivors who filled prescriptions for all three drugs for six months, studying how well they adhered to their prescription drug regimen. Being adherent was defined as taking the medicines as prescribed at least 80% of the time. The team then followed the patients for up to 18 months to see how many died during that time. Six months after their heart attack, about half the patients in the study had stopped taking at least one of their medications as prescribed, the researchers found.

For patients who took all three drugs as prescribed, the mortality rate at one year was 9.3%. For patients who adhered to ACE inhibitor or ARBs and statin prescriptions but not beta blockers, the mortality rate was 9.1%, a statistically insignificant different. For patients not taking any of the medicines as prescribed, the mortality rate was 14.3%, nearly 54% greater than for adherent patients.

Three-drug regimen adherence can be “difficult”

“The problem with this three-drug regimen is that it is difficult for people to take their meds 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,” Fang says.

Fang also noted that patients in the study who had diabetes, dementia or both were more likely to die when taking beta blockers as prescribed. Further research is warranted, he said, and physicians should exercise more caution in prescribing beta-blockers for elderly heart-attack survivors with diabetes or dementia.

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