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NEWS
Health News


LONG-TERM BETA-BLOCKER USE MAY NOT BENEFIT CERTAIN PATIENTS, STUDIES FIND

By Cyra-Lea Drummond, BSN, RN
Published on June 23, 2023
Fact checked by Nick Blackmer
 * 
 * 
 * 

Print

chapin31 / Getty Images.



KEY TAKEAWAYS

 * Beta-blockers are a tried-and-true class of medications prescribed to
   patients who have experienced a heart attack or have heart failure.
 * New research shows that long-term beta-blocker use may not improve outcomes
   in certain patients, particularly those whose heart function is only mildly
   reduced.
 * Individuals who have experienced a heart attack should take their medications
   as prescribed and see their cardiologist regularly to evaluate their
   treatment plan.

Beta-blockers are a long-standing treatment for patients after a heart attack
because they protect the heart from further damage. They also promote heart
function for those with cardiac dysfunction, or heart failure. But three new
studies published in close succession show that long-term beta-blocker use may
not benefit some patients as much as once thought.



Though researchers have identified some pitfalls of long-term beta-blocker use,
experts say these drugs will still be prescribed and are useful to many
patients. But there are several other heart disease treatments they want people
to know about, too.




WHAT ARE BETA-BLOCKERS AND WHY ARE THEY PRESCRIBED?

If you’ve ever ridden a rollercoaster or been frightened by someone sneaking up
behind you, you’ve likely experienced the effects of adrenaline, the body’s
“fight or flight” hormone. Adrenaline, also known as epinephrine, is a
catecholamine, a class of hormones the nervous system makes in response to
stress.



Adrenaline causes the heart rate and breathing to speed up. It also makes
arteries constrict, or get smaller, which raises your blood pressure. The body
releases a surge of adrenaline during times of stress, but it continually
produces small amounts to keep your blood pressure and heart rate within optimal
limits.



Beta-blockers block catecholamine receptor sites, particularly adrenaline, in
the heart and arteries.1 When beta-blockers prevent adrenaline from doing its
job, the heart rate slows down and arteries cannot constrict, reducing blood
pressure.


Using Beta Blocker Drugs


This effect is important after a heart attack, when the heart muscle surrounding
the blockage is weakened. The goal of a beta-blocker is to prevent heart muscle
from remodeling, or becoming stiff and fibrous, after a heart attack.2 Stiff
heart muscle cannot pump as efficiently, and this can lead to permanent heart
failure.



However, research suggests beta-blockers do not always achieve this goal.



There are many different beta-blockers, but the ones that are used most often to
treat heart failure are Zebeta (bisoprolol—now only available as a generic
drug), Coreg (carvedilol), and Toprol or Lopressor (metoprolol).


RECENT STUDIES EVALUATE BETA-BLOCKER USE


Three recent studies evaluated the merits of beta-blocker use among either heart
attack or heart failure patients. Each concluded that beta-blockers are not
right for everyone.3




BETA-BLOCKERS AFTER A HEART ATTACK

Two of the studies looked specifically at heart attack patients.



The first study followed 43,618 patients in Sweden who were prescribed
beta-blockers after a heart attack between 2005 and 2016. Researchers concluded
that beta-blocker use beyond one year did not improve cardiovascular outcomes
for patients who did not develop heart failure after their heart attack.4



The second study reviewed data from 262,972 patients who had their first heart
attack between 2018 and 2023. Of these patients, 80% had been prescribed
beta-blockers after their heart attacks. Across all demographics of patients,
researchers found that patients who received beta-blockers had a 16.5% greater
chance of experiencing a second heart attack within the first year.5


Cardiac Arrest vs. Heart Attack: Main Differences



BETA-BLOCKERS FOR HEART FAILURE

The third study evaluated heart failure patients instead of heart attack
survivors, and measured something called ejection fraction.



Ejection fraction (EF) can be an important metric for heart failure that can be
measured with an echocardiogram, or heart ultrasound. It refers to the
percentage of blood pumped out of the heart’s lower chambers with each beat. The
lower the EF, the less efficiently the heart is pumping, resulting in a lack of
adequate blood flow through the body.3


 * An EF of 50–70% is considered “normal.” Your heart can circulate enough blood
   to meet your body’s needs.
 * An EF of 41–49% is “borderline.” With a slightly lower EF, you may notice
   some symptoms like shortness of air with activity.
 * An EF of 40% or less is significantly reduced. Normal daily activities can
   become difficult to perform without fatigue, and you may be short of breath
   at rest.

A low EF can indicate heart failure, but it is not present in all heart failure
patients.

Researchers evaluated 435,897 patients aged 65 and older with heart failure on
beta-blockers.6 All patients had an EF of 40% and above, so none of the patients
had severely reduced heart function. Researchers found that for patients with an
EF between 40% and 60%, the benefits of beta-blockers actually decreased as the
EF increased.



The researchers also concluded there was no survival benefit to beta-blockers in
patients with an EF above 60%. In fact, a patient’s risk of developing heart
failure or experiencing hospitalization and death was actually greater if they
continued on beta-blockers as EF increased.




WHAT DOES THIS MEAN FOR THE FUTURE OF HEART DISEASE CARE?

Much of the long-term damage of a heart attack results from lack of blood flow
to the heart, and beta-blockers are not the only way to get that back on track.



“We have such good strategies for quickly restoring blood flow to the heart that
many of the historical benefits of beta-blockers are negated,” Andy Lee, MD, a
cardiologist with UCI Health in Irvine, California, told Verywell.



Stents, cholesterol-lowering medications, and cardiac rehabilitation are other
treatment options that reduce recurrent heart disease risk after a heart attack.



The decision to continue beta-blockers can be nuanced, and requires a discussion
between the patient and provider.



“Beta-blockers are great drugs for patients that have already had a heart
attack, but long-standing beta-blocker therapy is not always indicated,” Lee
said. “Someone who is physically active may be more sensitive to being on a
beta-blocker. However, if they are experiencing chest pain or have a low EF, a
beta-blocker may be more beneficial.”



When it comes to heart failure, beta-blockers still play a vital role in
improving long-term outcomes for some patients, especially those with low EF.



“For people with heart failure with weakened heart muscle, beta-blockers remain
the standard of care unless they have contraindications,” Deepak L. Bhatt, MD,
MPH, Director of Mount Sinai Heart in New York City, told Verywell, adding that
patients with atrial fibrillation are also candidates for beta-blocker therapy.




Beta-blockers are only one class of medication used to treat heart failure. Four
classes of medications, known as the “four pillars” of heart failure treatment,
are recommended for heart failure management. In addition to beta-blockers, a
cardiologist may recommend:


 * ACE inhibitors, ARBs, or ARNIs: These medications reduce blood pressure and
   prevent remodeling of the heart muscle.
 * Mineralocorticoid receptor antagonists (MRAs): These are mild diuretics. They
   alleviate excess fluid build-up in heart failure. The most common example is
   the drug spironolactone.
 * Sodium-glucose co-transporter 2 inhibitors: These are a relatively new class
   of medications originally designed to treat type 2 diabetes. Recent evidence
   shows they can improve heart function for patients with heart failure with
   reduced ejection fraction (HFrEF) independent of diabetes status. Farxiga and
   Jardiance are the most popular drugs in this class for heart failure.



“Professional guidelines continue to be updated. Many of these drugs are
underutilized, and we want to encourage providers to prescribe them unless they
are contraindicated,” Bhatt said. “The goal is to get all four classes of drugs
on board, even if at lower doses.”




WHAT THIS MEANS FOR YOU

Beta-blockers remain important medications for patients whose hearts do not
function optimally. Do not stop any medications without speaking to your
provider first. If you have had a heart attack or you have heart failure, see
your cardiologist regularly to discuss your medications and treatment plan.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies,
to support the facts within our articles. Read our editorial process to learn
more about how we fact-check and keep our content accurate, reliable, and
trustworthy.

 1. Oliver E, Mayor F Jr, D'Ocon P. Beta-blockers: historical perspective and
    mechanisms of action. Rev Esp Cardiol (Engl Ed). 2019;72(10):853-862.
    doi:10.1016/j.rec.2019.04.006

 2. Garza MA, Wason EA, Zhang JQ. Cardiac remodeling and physical training post
    myocardial infarction. World J Cardiol. 2015;7(2):52-64.
    doi:10.4330/wjc.v7.i2.52

 3. American Heart Association. Ejection fraction heart failure measurement.

 4. Ishak D, Aktaa S, Lindhagen L, et al. Association of beta-blockers beyond 1
    year after myocardial infarction and cardiovascular outcomes. Heart.
    Published online May 2, 2023. doi:10.1136/heartjnl-2022-322115

 5. Epic Research. Beta blocker prescription after acute MI might not reduce
    rate of subsequent MIs.

 6. Arnold SV, Silverman DN, Gosch K, et al. Beta-blocker use and heart failure
    outcomes in mildly reduced and preserved ejection fraction. JACC Heart Fail.
    Published online May 1, 2023. doi:10.1016/j.jchf.2023.03.017

By Cyra-Lea Drummond, BSN, RN
 Cyra-Lea, BSN, RN, is a writer and nurse specializing in heart health and
cardiac care.

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