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Half of patients discharged from the hospital after a heart attack are unnecessarily treated with beta-blockers. This is according to a new study published in the journal New England Medical Journal. “We are confident that this will have implications for future practice,” says Thomas Jernberg, professor at Karolinska Institutet and principal investigator of the study.

Currently, patients are routinely treated with beta-blockers such as metoprolol and bisoprolol when they are discharged from the hospital after an acute heart attack. Now, new research shows that about half of them do not benefit from treatment and should not receive treatment at all. These are patients who have had a mild heart attack but whose heart function is preserved afterwards. This study will change the way patients are treated in the future, said Professor Thomas Jernberg, lead researcher from the Department of Clinical Sciences at Karolinska Institutet and final author of the study.

“We are confident that this will have an impact on future practice. This study has already been mentioned in European guidelines for cardiac care, so the results are needed,” he says.

The project was led by researchers from Karolinska Institutet, Lund University and Uppsala University. More than 5,000 patients with mild heart attacks at 45 hospitals in Sweden, Estonia and New Zealand were randomly assigned to receive a beta-blocker or not at the time of discharge.

The study began in September 2017 and patients will be followed until November 2023, by which time 7.9% of patients receiving beta blockers will have died or had a new heart attack as the primary outcome. compared with 8.3% in patients not receiving beta-blockers. This difference is not statistically significant. There were also no differences between groups in secondary outcomes.

The result, says Thomas Jernberg, is that, unusually, it means drug treatment becomes easier and cheaper for all involved.

“Normally new research results in adding a drug to a patient’s regimen. But this study shows that patients can benefit from taking one less drug.” ”

But he is quick to warn patients not to stop treatment voluntarily. The current study is only about the effects of starting treatment after a small heart attack, not after a major heart attack. There is also no indication of the effects of discontinuing treatment. More importantly, discontinuing medication should always be done in consultation with your doctor.

“There are several reasons for this. There may be other causes or other diagnoses behind beta-blocker use. And if you decide to stop, beta-blockers may need to be discontinued gradually. There is also the fact that if you do it too, you may experience palpitations and other discomfort immediately. That is why it is very important to consult your doctor before discontinuing your heart medication. ,” says Thomas Jernberg.

This study was funded by the Swedish Research Council and the Swedish Heart and Lung Foundation. The researchers report no conflicts of interest.

fact:

Approximately 20,000 people in Sweden have a heart attack each year. Half of them have a mild heart attack, but their heart continues to function. This means that the heart is still able to pump out more than 50% of the heart’s left ventricular volume, which is known as preserved left ventricular systolic function.

The reason behind the current practice of giving everyone beta blockers after a heart attack can be traced back to the 1980s, when research clearly showed that it was beneficial. But since then, advances in other cardiovascular treatments and diagnostics have allowed doctors to detect many heart attacks that weren’t previously classified as infarctions. This, combined with the fact that the incidence of heart attacks has been steadily declining since the 1980s, means that today’s heart attacks are generally smaller and a higher proportion of people have preserved left ventricular function. To do.

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