important point
- Beta-blockers are proven drugs prescribed to patients who have had a heart attack or heart failure.
- A new study shows that long-term use of beta-blockers may not improve outcomes for certain patients, especially those with only mildly impaired cardiac function.
- People who have had a heart attack should take prescribed drugs and see a cardiologist regularly to evaluate their treatment plan.
Beta-blockers have long been a treatment for post-heart attack patients because they protect the heart from further damage. It also promotes cardiac function in people with cardiac insufficiency or heart failure. But three new studies in quick succession show that long-term use of beta-blockers may not be as beneficial for some patients as once thought.
Researchers have identified some pitfalls of long-term beta-blocker use, but experts say these drugs will continue to be prescribed and useful for many patients. But there are a few other treatments for heart disease that people want to know about.
What are beta blockers and why are they prescribed?
If you’ve ever ridden a roller coaster or been frightened by someone creeping up behind you, you’ve probably experienced the effects of adrenaline, your body’s “fight or flight” hormone. Adrenaline, also known as epinephrine, catecholaminea type of hormone produced by the nervous system in response to stress.
Adrenaline increases heart rate and breathing. Also, arteries constrict or shrink, increasing blood pressure. Although the body releases large amounts of adrenaline when stressed, small amounts of adrenaline are continually produced to keep blood pressure and heart rate within optimal limits.
Beta-blockers block catecholamine receptor sites in the heart and arteries, especially adrenaline. Beta-blockers block the action of adrenaline, slowing heart rate, preventing arteries from constricting, and lowering blood pressure.
This effect is important after a heart attack, when the heart muscle around the blockage is weakened. The purpose of beta-blockers is to prevent the heart muscle from remodeling, hardening, and fibrosis after a heart attack. Stiff heart muscle can reduce pump efficiency and lead to permanent heart failure.
However, research suggests that beta-blockers do not always achieve this goal.
Recent Study Evaluates Use of Beta-Blockers
Three recent studies evaluated the benefits of beta-blocker use in heart attack or heart failure patients. Each concluded that beta-blockers are not for everyone.
beta blockers after heart attack
Two of the studies were specifically for heart attack patients.
The first study followed 43,618 Swedish patients who were prescribed beta-blockers after a heart attack between 2005 and 2016. The researchers concluded that use of beta-blockers for more than one year did not improve cardiovascular outcomes in patients who did not develop heart failure after a heart attack. .
A second study looked at data from 262,972 patients who had their first heart attack between 2018 and 2023. Of these patients, 80% were prescribed beta-blockers after their heart attack. The researchers found that across all patient demographics, patients taking beta-blockers were 16.5% more likely to experience a second heart attack within a year.
beta-blockers for heart failure
A third study evaluated heart failure patients instead of heart attack survivors and measured something called ejection fraction.
Ejection fraction (EF) is an important indicator of heart failure and can be measured by echocardiography and echocardiography. It refers to the percentage of blood pumped out of the lower chambers of the heart with each beat. The lower the EF, the less efficient the heart is in pumping, resulting in a lack of proper blood flow through the body.
- An EF of 50-70% is considered “normal.” The heart can circulate enough blood to meet the body’s needs.
- EF 41-49% is “borderline”. A slightly lower EF may cause symptoms such as shortness of breath during activity.
- EF below 40% is significantly reduced. It becomes difficult to do normal daily activities without fatigue, and people may feel short of breath at rest.
A low EF may indicate heart failure, but it is not present in all heart failure patients.
Researchers evaluated beta-blocker administration in 435,897 heart failure patients aged 65 years and older. All patients had an EF of 40% or greater, so no patient had significant cardiac dysfunction. Investigators found that in patients with EFs between 40% and 60%, the effectiveness of beta-blockers actually decreased as EF increased.
The researchers also concluded that beta-blockers had no survival benefit in patients with an EF greater than 60%.In fact, the risk of a patient developing heart failure or being hospitalized and dying is actually bigger If EF increased but beta blockers continued.
What does this mean for the future of cardiac care?
Much of the long-term damage from a heart attack is caused by insufficient blood flow to the heart, and beta-blockers aren’t the only way to get it back to normal.
“There is a superior strategy to quickly restore blood flow to the heart, thus negating many of the historical benefits of beta-blockers.” Dr. Andy Leecardiologist UCI Health told Verywell in Irvine, California.
Stents, cholesterol-lowering drugs, and cardiac rehabilitation are other treatment options that reduce the risk of heart disease recurring after a heart attack.
The decision to continue beta-blockers is nuanced and should be discussed between the patient and the healthcare professional.
“Beta-blockers are great drugs for people who have already had a heart attack, but long-term beta-blocker treatment is not always indicated,” Lee said. “Physically active people can be sensitive to taking beta blockers. may be more beneficial.”
Regarding heart failure, beta-blockers still play an important role in improving long-term outcomes for some patients, especially those with low EF.
“For heart failure patients with weakened myocardium, beta-blockers continue to be the standard of care unless contraindicated.” Deepak L. Butt, MD, MPHdirector mount sinai heart Speaking to Verywell in New York City, he added that patients with atrial fibrillation are also candidates for beta-blocker treatment.
Beta-blockers are just one class of drugs used to treat heart failure.four classes of drugs known as The “four pillars” of heart failure treatment, is recommended for the management of heart failure. In addition to beta-blockers, cardiologists may recommend:
- ACE inhibitors, ARBs, or ARNIs: These drugs lower blood pressure and prevent myocardial remodeling.
- Mineralcorticoid Receptor Antagonists (MRAs): These are mild diuretics. They relieve excess fluid buildup in heart failure. The most common example is the drug spironolactone.
- Sodium-glucose cotransporter 2 inhibitors: These are a relatively new class of drugs originally designed to treat type 2 diabetes. Recent evidence indicates that it can improve cardiac function in heart failure patients with reduced ejection fraction (HFrEF), independent of diabetic status. Farxiga and Jardiance are the most popular drugs in this class of heart failure drugs.
“Professional guidelines continue to be updated. Many of these drugs are underutilized and we want to encourage healthcare providers to prescribe them unless they are contraindicated,” Batt said. “The goal is to introduce all four classes of drugs, even at low doses.”
what this means for you
Beta-blockers remain important drugs for patients whose heart is not functioning optimally. Do not stop taking your medicine without first talking to your doctor. If you’ve had a heart attack or have heart failure, see your cardiologist regularly to discuss medications and treatment plans.
