Bisoprolol

At the ESC Congress, Dr. Milton Packer highlighted recent research into beta blocker treatment for myocardial infarction. Credit: luchschenF via Shutterstock. A shift in the beta-blocker treatment paradigm has arrived with the changing myocardial infarction treatment landscape, said a researcher at the European Society of Cardiology (ESC) Congress, held from 31 August to 2 September. Over the past 40 years, the research space has operated on an understanding that immediate inhibition by beta-blockers reduces left ventricular rupture, and further myocardial infarction , said Dr. Milton Packer, distinguished scholar in cardiovascular science at Baylor University Medical Center, Dallas. Additionally, the belief was that delayed long-term blockade can lead to left ventricular dysfunction, he said. Beta-blockers are a class of drugs that act by inhibiting the actions of hormones such as adrenaline to slow down the heart. Commonly used beta blockers include Abbott ’s Tenormin (atenolol), MSD’s Cardicor (bisoprolol), and GSK ’s Trandate (labetalol). However, Packer explained that the beta blocker response has changed as percutaneous interventions, reperfusion therapies, antiplatelet drugs and more have entered the treatment landscape for myocardial infarction. At the ongoing ESC Congress talk titled “Should we give beta blockers post-myocardial infarction?” Packer said that questions have been raised surrounding the use of the drugs in patients with myocardial infarction and preserved ejection fraction, referencing the Phase IIII REDUCE-AMI study (NCT03278509). See Also: Novavax wins FDA emergency approval for updated Covid-19 vaccine Combating Pharmaceutical Crime with On-Dose Authentication REDUCE-AMI, which was funded by the Swedish Research Council, tested the use of beta-blockers after myocardial infarction and preserved ejection fraction. The study found that for patients with acute myocardial infarction who underwent early coronary angiography and had preserved left ventricular ejection fraction, long-term beta-blocker treatment did not lower the risk of death from any cause or new myocardial infarctions compared to no beta-blocker use. Despite the conclusion of the REDUCE-AMI study, Packer highlighted the fact that researchers have only investigated and proven the effectiveness of non-selective beta blockers in post-myocardial infarction trials, so further research is required. He added that physicians will have to take into account the degree of beta-blockade in future treatment regimens.

Half of all patients discharged from hospital after a heart attack are treated with beta-blockers unnecessarily, new study suggests. Half of all patients discharged from hospital after a heart attack are treated with beta-blockers unnecessarily. This is according to a new study published in the New England Journal of Medicine. "I am convinced that this will influence future practice," says Tomas Jernberg, Professor at Karolinska Institutet and lead researcher of the study. Today, when patients are discharged from hospitals after an acute heart attack, they are regularly treated with beta-blocker drugs such as metoprolol and bisoprolol. Now new research shows that about half of them do not benefit from the treatment and should not receive it at all. These are the patients who have suffered a small heart attack and have retained heart function afterwards. The study will change the way patients are treated in the future, says the lead researcher and last author of the study, Professor Tomas Jernberg from the Department of Clinical Sciences at Karolinska Institutet. "I am convinced that this will influence future practice. This study has already been mentioned in the European guidelines for cardiac care, so the results are in demand," he says. The project was led by researchers at Karolinska Institutet, Lund University and Uppsala University. More than 5,000 patients at 45 hospitals in Sweden, Estonia and New Zealand who suffered a small heart attack were randomized to either receive or not receive beta-blockers at discharge. The study began in September 2017 and patients were followed up until November 2023, by which time 7.9 percent of those receiving beta-blockers had the primary outcome of death or a new heart attack, compared to 8.3 percent of those not receiving beta-blockers. This difference is not statistically significant. Nor was there any difference between the groups in the secondary outcomes. The result means that, unusually, the drug treatment becomes simpler and cheaper for all parties, says Tomas Jernberg. "Typically, new research results in the addition of a medication to a patient's regimen. However, this study shows that patients will benefit from taking one fewer drug." " But he immediately warns patients not to stop their treatment on their own accord. The current study is only about the effect of starting treatment after a small heart attack, not after a larger one. Nor does it show anything about the effects of stopping treatment. More importantly, stopping medication should always be done in consultation with the treating physician. "This is for several reasons. There may be other causes, other diagnoses, behind the use of beta-blockers. Then there is the fact that if you are going to stop, you should stop beta-blockers gradually. If you do it too quickly, you can get some heart palpitations and other discomfort. So, it is very important that you talk to your doctor before stopping any heart medication," says Tomas Jernberg. The research was funded by the Swedish Research Council and the Swedish Heart-Lung Foundation. The researchers report that there are no conflicts of interest. Facts: In Sweden, around 20,000 people have a heart attack every year. Half of them have a small heart attack with retained heart function afterward. This means that the heart can still pump out more than 50 percent of the volume in the left chamber of the heart, known as preserved left ventricular systolic function. The reasons behind the current practice of giving everyone a beta-blocker after a heart attack can be traced back to the 1980s when studies showed unequivocally that it was beneficial. But since then, other cardiovascular treatments have improved, as have diagnostics, so doctors are now detecting many of the heart attacks that were never classified as infarctions before. This, together with the fact that the incidence of heart attacks has steadily declined since the 1980s, means that today's heart attacks are generally smaller and with a higher proportion of people with preserved left ventricular function.