Beta blockers not needed for heart attack survivors taking these drugs

Beta blockers are not needed after a heart attack if heart attack survivors are taking ACE inhibitors and statins, according to a new study.

The study, published in the Journal of the American College of Cardiology, 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.

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 angiotensin receptor blocker and statin as preventive therapies after they were discharged from the hospital.                                        

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.

The retrospective cohort study used a 100% sample from Medicare Chronic Condition Data Warehouse research files, including medical services and prescription Part D event files. Regression analysis adjusted for patient baseline sociodemographic and clinical characteristics was applied to address the research questions.

Key findings

Fang

Gang Fang, PharmD, MS, PhD, an assistant professor at the UNC Eshelman School of Pharmacy and colleagues, found that:

·      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 difference.

·      For patients not taking any of the medicines as prescribed, the mortality rate was 14.3%, a nearly 54% increase over adherent patients.

“If elderly heart attack survivors are consistently taking an ACE inhibitor or ARB and statin therapy but are unable to take the beta-blocker as prescribed, there is not a significant effect on mortality,” says Fang, senior author of the study.

“In other words, taking beta blockers as prescribed does not further reduce the risk of death among elderly heart attack survivors when they take ACE inhibitors/ARBs and statins as prescribed,” Fang says.

Broader implications

More than half of patients became non-adherent to evidence-based therapies within six months after they were discharged from hospital for heart attack, says Fang.

“This puts these patients at enormous risk for death or costly hospital readmissions for another heart attack, stroke and heart failure,” he says. “On the other side, these elderly heart attack patients on average were taking more than 10 different medications and the burden of taking so many medications and risk for side effects and drug-drug interaction is also high. Many of them just could not take all the medications in long term. Understanding treatment regimen with less complexity but similar health outcomes may help address this paradox problem.”

In previous studies, Fang and colleagues noticed many patients were not adherent to all three therapies recommended by clinical guidelines after heart attack.