Beta-Blockers Not Needed Following Myocardial Infarction

β-blockers are not necessary following myocardial infarction if patients are already taking ACE inhibitors and statins, according to the results of a recent study.

Although current guidelines recommend that patients take statins, ACE inhibitors, and β-blockers following a heart attack, patients may adhere to some, but not all, of these therapies, according to the researchers.
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For their study, they examined data from 90,869 Medicare beneficiaries aged 65 years or older who had prescriptions for ACE/ARBs, β-blockers who survived more than 180 days following myocardial infarction hospitalization.

Cox proportional hazard models were used to estimate hazard ratios (HRs) of mortality for groups adherent to 2, 1, or none of the prescribed therapies.

Overall, only 49% of the patients adhered to all 3 of the prescribed therapies. Compared with those who took all 3, HRs for mortality were 1.12 for ACE/ARBs and β-blockers only, 0.98 for ACE/ARB and statins only, 1.17 for β-blockers and statins only, 1.19 for ACE/ARB only, 1.32 for β-blockers only, 1.26 for statins only, and 1.65 for nonadherence to all therapies.

“Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all 3 therapies, suggesting limited additional benefit for β-blockers in patients who were adherent to statins and ACE inhibitors/ARBs. Nonadherence to ACE inhibitors/ARBs and/or statins was associated with higher mortality.”

—Michael Potts

Reference:

Korhonen MJ, Robinson JG, Annis IE, et al. Adherence tradeoff to multiple preventive therapies and all-cause mortality after acute myocardial infarction. JACC. 2017;70(13).