New Data Question Beta-Blockers Post-MI With Preserved EF
Introduction
For decades, beta-blockers have been the go-to medication for heart attack patients to reduce the risk of future cardiovascular events. However, a recent study published in the New England Journal of Medicine challenges this practice, suggesting that beta-blockers may not benefit all heart attack patients.
Long-Term Beta-Blocker Use in Preserved EF
The study, called REDUCE-AMI, investigated the long-term effects of beta-blockers in patients who had a heart attack but had preserved left ventricular ejection fraction (EF), a measure of heart function. EF is considered preserved when it is above 50%.
Researchers enrolled over 5,000 patients with a preserved EF who had undergone coronary angiography, a procedure to diagnose blockages in the heart arteries. Patients were randomly assigned to receive either beta-blockers (metoprolol or bisoprolol) or no beta-blockers for an average follow-up of 3.5 years.
No Benefit Seen
To the surprise of researchers, the study found that long-term beta-blocker use did not reduce the risk of death from any cause or incident myocardial infarction (MI) compared to patients who did not receive beta-blockers. This held true even for patients with a history of diabetes or prior heart attack.
“These findings suggest that routine prescription of beta-blockers may not be necessary for patients with a heart attack and a preserved heart function,” said Dr. Tomas Jernberg, lead author of the study.
Safety Concerns
While beta-blockers did not provide any benefits, there were some safety concerns raised. Patients taking beta-blockers were more likely to experience low blood pressure and a slow heart rate, which can lead to symptoms such as dizziness or fatigue.
Implications for Practice
The REDUCE-AMI trial has significant implications for the clinical management of heart attack patients with preserved EF. It suggests that beta-blockers may not be necessary in this population and could even be harmful.
“For patients with reduced heart function or heart failure, beta-blockers are still recommended, as they have been shown to improve survival and symptoms,” emphasized Dr. Jernberg.
Conclusion
The REDUCE-AMI trial provides important data that challenges the long-standing practice of prescribing beta-blockers to all heart attack patients with preserved EF. Future studies are needed to determine which patients may still benefit from beta-blocker therapy. In the meantime, physicians are urged to carefully consider the risks and benefits before prescribing beta-blockers to heart attack patients with a preserved EF.
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Mehek 
Divya