In Brief | Cardiovascular Disease
Assessing the efficacy of long-term beta-blocker treatment interruption versus continuation following myocardial infarction.
Time to read: 02:08 minutes
Time to listen: 04:39 minutes
Originally Published: 30 August 2024
Sourced: NEJM
Type of article: In Brief
MedED Catalogue Reference: MCIB003
Category: Cardiovascular Disease
Cross Reference: Gerontology
Keywords: myocardial infarction, beta blockers, cardiovascular disease
Interruption of long-term beta-blocker treatment after myocardial infarction did not demonstrate noninferiority compared to continued treatment, with a higher incidence of primary outcomes in the interruption group. Additionally, quality of life was not improved by discontinuing beta-blockers, suggesting that ongoing treatment may be more beneficial.
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Originally published in NEJM,30 August 2024 This summary does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information
In the current reperfusion era, the benefit of beta-blockers remains clear only for patients with reduced ejection fraction (EF ≤40%). For those with mildly reduced or preserved EF, the optimal duration and overall benefit of oral beta-blocker therapy remain questionable, largely due to the absence of randomized clinical trials addressing this specific population.1
Participants were required to have a left ventricular ejection fraction of at least 40% and no history of cardiovascular events in the six months preceding their enrollment.
Endpoints:
The primary endpoint was a composite measure encompassing death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for cardiovascular reasons.
The main secondary endpoint assessed changes in quality of life, measured using the European Quality of Life – 5 Dimensions questionnaire.
The following findings were recorded:
A primary outcome event occurred in 432 of 1,812 patients (23.8%) in the interruption group, compared to 384 of 1,821 patients (21.1%) in the continuation group.
This reflected a risk difference of 2.8 percentage points and a 16% higher hazard ratio (HR: 1.16; 95% CI: 1.01 to 1.33; P=0.44 for non-inferiority).
The study found no significant improvement in patient's quality of life following the interruption of beta-blocker treatment.
Silvain, J., Cayla, G., Ferrari, E., Range, G., Puymirat, E., Delarche, N., Guedeney, P., Cuisset, T., Ivanes, F., Lhermusier, T., Petroni, T., Lemesle, G., Bresoles, F., Labeque, J. N., Pommier, T., Dillinger, J. G., Leclercq, F., Boccara, F., Lim, P., Besseyre des Horts, T., … ABYSS Investigators of the ACTION Study Group (2024). Beta-Blocker Interruption or Continuation after Myocardial Infarction. The New England journal of medicine, 391(14), 1277–1286. https://doi.org/10.1056/NEJMoa2404204
Additional references
1. Joo S. J. (2023). Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it. Acute and critical care, 38(3), 251–260. https://doi.org/10.4266/acc.2023.00955
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