How Does the Long-Term Effect of Beta Blocker Use Affect Clinical Outcomes in Patients After Myocardial Infarction?
In patients after myocardial infarction (MI), beta blockers (BB) still hold an important place in secondary prevention according to recommended procedures. However, the question could be their long-term effect on clinical outcomes, as different results can be found in the literature – this fact led the authors of the work cited below to perform a systematic review and meta-analysis of studies dedicated to this issue.
Introduction
Analyzed Studies
Therefore, the authors of the meta-analysis searched for studies on the long-term impact of BB on clinical outcomes in patients after MI, published up to July 2021 in databases PubMed, Web of Science, Medline, Embase, and Google Scholar. They included randomized controlled trials or observational studies with a minimum follow-up of 6 months. The final analysis included 29 studies, 22 retrospective and 7 prospective. Retrospective studies encompassed a total of 173,438 patients with BB and 31,836 without BB, and prospective studies 22,557 patients with BB and 14,182 without BB. In total, 24 studies evaluated overall mortality.
Stata 12.0 software was used to calculate hazard ratios (HR) and their 95% confidence intervals (CI).
Findings
In the group of post-MI patients treated with BB, significantly lower overall mortality, cardiovascular mortality, and the incidence of major CV events were found compared to individuals after MI who did not receive BB (overall mortality: HR 0.67; 95% CI 0.56–0.80; CV mortality: HR 0.62; 95% CI 0.49–0.78; major CV events: HR 0.87; 95% CI 0.75–1.00).
No significant influence of long-term BB administration was observed on the risk of heart failure hospitalization (HHF), MI recurrence, stroke occurrence, or repeated revascularization in post-MI patients (HHF risk: HR 0.82, 95% CI 0.58–1.16; MI recurrence risk: HR 0.93; 95% CI 0.78–1.11; stroke risk: HR 0.94, 95% CI 0.79–1.12; repeated revascularization risk: HR 0.91; 95% CI 0.80–1.04).
Conclusion
The cited meta-analysis demonstrated a significant impact of long-term beta blocker administration on overall mortality, cardiovascular mortality, and the risk of major CV events in post-MI patients. Conversely, it did not show a significant reduction in the risk of heart failure hospitalization, MI recurrence, stroke occurrence, or repeated revascularization in these patients.
Source: Liang C., Zhang C., Gan S. et al. Long-term effect of β-blocker use on clinical outcomes in postmyocardial infarction patients: a systematic review and meta-analysis. Front Cardiovasc Med 2022 Apr 8; 9: 779462, doi: 10.3389/fcvm.2022.779462.
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