Beta-blockers are commonly prescribed after a heart attack to lower blood pressure, but researchers conducted a large trial to determine if they provide benefits in people with preserved ejection fraction after a heart attack. The study found that beta-blockers had no significant benefit in individuals with normal heart function post-heart attack, challenging the conventional belief that they are universally beneficial in this circumstance. Heart attacks, a leading cause of death, are typically caused by coronary heart disease and can present symptoms such as chest pain, shortness of breath, and nausea. One measurement of heart health is ejection fraction, which indicates how well the left ventricle of the heart pushes out blood.
The REDUCE-AMI trial aimed to determine if beta-blockers reduce the risk of death or another heart attack in individuals who had experienced a heart attack with a normal ejection fraction. The study, which began in 2017 and lasted until 2023, involved 5,020 participants from 45 healthcare centers who were randomly assigned to receive beta-blockers or not. Results revealed that beta-blockers did not provide an overall benefit, as there was no significant difference in all-cause death or primary outcomes (death or new heart attack) between the beta-blocker and no-beta-blocker groups. The research challenged the standard practice of prescribing beta-blockers after a heart attack and indicated a potential need for updated guidelines in this regard.
Lead study investigator Dr. Tomas Jernberg expressed the likelihood of guidelines shifting to reduce the prescription of beta-blockers in patients with heart attacks and normal heart function. However, he emphasized that the study focused only on individuals with preserved ejection fraction and not those with reduced heart function. While beta-blockers have many benefits, they can also lead to side effects such as slowed heart rate, worsened heart failure, asthma, and depression. Dr. Cheng-Han Chen, an interventional cardiologist, noted that this single study may not immediately change the approach to beta-blockers in such patients, but ongoing trials may shed further light on the topic and potentially impact clinical practice.
Dr. Khashayar Hematpour highlighted the potential bias in the study due to physicians and patients being aware of who was receiving beta-blockers, which could influence the results. He pointed out that while beta-blockers are well-tolerated overall, they can cause side effects like fatigue, weakness, and memory loss. Dr. Chen suggested that not prescribing beta-blockers to patients with normal heart function after a heart attack could simplify medication management for patients undergoing significant drug regimens. Overall, the findings of the REDUCE-AMI trial challenge the traditional use of beta-blockers in individuals with preserved ejection fraction post-heart attack, prompting a reconsideration of current prescribing practices and potential guideline changes in the future.
