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Beta-blockers fail to improve outcomes, may raise HF risk after PCI
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Despite increasing use, beta-blockers did not improve mortality rates or reduce CV events for patients aged at least 65 years with stable angina but no history of MI or HF, according to a new study.
However, 3-year readmission rates for HF were higher in those who were assigned beta-blockers than in those who were not assigned beta-blockers, according to the researchers.
The researchers sought to determine whether beta-blockers affected outcomes in patients with stable angina after PCI, expanding on established evidence that beta-blockers are beneficial in patients with MI and/or systolic HF.
Apurva Motivala, MD, from the division of cardiology at Columbia University, and colleagues evaluated patients aged at least 65 years without history of MI, left ventricular ejection fraction of less than 40% or systolic HF who underwent PCI from 2005 to March 2013 at 1,443 sites from the CathPCI Registry of the National Cardiovascular Data Registry. They evaluated the cohort for trends and predictors of beta-blocker prescriptions at the point of discharge.
Apurva Motivala
The researchers analyzed data from 755,215 patients, 71.4% of whom were discharged using beta-blockers. The outcomes of interest were all-cause mortality, revascularization or hospitalization for MI, HF or stroke at 30 days and 3 years.
Few differences
Between 2005 and 2013, prescriptions for beta-blockers at discharge rose in this cohort (P < .001), the researchers wrote.
Motivala and colleagues found no difference in the 3-year adjusted mortality rate between those taking beta-blockers and those not taking them (beta-blockers, 14%; no beta-blockers, 13.3%; adjusted HR = 1; 95% CI, 0.96-1.03). For MI at 3 years, the numbers were similar (beta-blockers, 4.2%; no beta-blockers, 3.9%; adjusted HR = 1; 95% CI, 0.93-1.07).
At 3 years, there were no significant differences between the groups in stroke (beta-blockers, 2.3%; no beta-blockers, 2%; adjusted HR = 1.08; 95% CI, 0.98-1.18) or revascularization (beta-blockers, 18.2%; no beta-blockers, 17.8%; adjusted HR = 0.97; 95% CI, 0.94-1.01).
Motivala and colleagues found, however, that beta-blockers in this population were associated with elevated risk for readmission for HF at 3 years (8% vs. 6.1%; adjusted HR = 1.18; 95% CI, 1.12-1.25).
The researchers observed similar trends at 30 days.
Questions raised
Anthony G. Nappi, MD, from Albany Medical College, New York, and William E. Boden, MD, from the Clinical Trials Network, VA New England Healthcare System, Boston, wrote in an accompanying editorial, “For years, clinicians have extrapolated the evidence of beta-blocker benefit from the … older post-MI trials and applied it to all patients with CAD.”
However, they wrote, “This study … raises questions about the continued role of beta-blocker usage in patients with CAD undergoing PCI. It seems increasingly difficult to justify” guideline recommendations of beta-blocker use “where the evidence of clinical benefit in patients without prior MI or [HF]/LV dysfunction is largely lacking.” – by James Clark
Disclosure: Motivala, Boden and Nappi report no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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