What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction (n=43618). Intervention: Beta-blockers vs. No beta-blockers. Primary outcome: Composite of all-cause mortality, recurrent MI, unscheduled revascularisation, and hospitalisation for heart failure (HR 0.99, 95% CI 0.93 to 1.04).

What question did this study set out to answer?

To determine the role of beta-blockers beyond the first year after myocardial infarction in patients without heart failure or left ventricular systolic dysfunction.

May 2, 2023HeartOpen Access

Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes

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Key result

Continuing beta-blockers beyond 1 year post-MI shows no benefit for cardiovascular outcomes.

HR 0.99
95% CI 0.93 to 1.04
n=43,618

Why the study?

It remains uncertain whether beta-blockers beyond the first year after MI provide benefit in patients without heart failure or left ventricular systolic dysfunction.

Does beta-blocker therapy reduce a composite of all-cause mortality, recurrent MI, unscheduled revascularisation, or hospitalisation for heart failure in patients with MI without heart failure or LVSD beyond 1 year?

Population

43 618 patients 1 year post-MI without heart failure or LVSD in Sweden

Comparison

Beta-blocker treatment vs no beta-blocker treatment at 1 year post-MI

Design

Nationwide registry-based cohort study

Authors

DIDivan IshakUppsala University SASuleman AktaaSt. Paul's Hospital LLLars LindhagenUppsala University

Discussion

Member takes

Implication

Should not yet change beta-blocker prescribing post-MI without HF/LVSD; challenges weak observational consensus and leaves open need for RCTs.

Key Points

To determine the role of beta-blockers beyond the first year after myocardial infarction in patients without heart failure or left ventricular systolic dysfunction.
Conducted a nationwide cohort study in Sweden from 2005 to 2016.
Included 43,618 patients with myocardial infarction.
Excluded patients with heart failure or left ventricular systolic dysfunction up to the index date.
Evaluated outcomes including all-cause mortality, myocardial infarction, hospitalisation for heart failure.
Used Cox and Fine–Grey regression models after inverse propensity score weighting.
34,253 patients (78.5%) received beta-blockers, and 9,365 (21.5%) did not at the index date.
Unadjusted primary outcome rate was lower in the beta-blocker group (3.8 vs 4.9 events/100 person-years).
After multivariable adjustment, risk of primary outcomes was not significantly different between groups (HR 0.99; 95% CI 0.93 to 1.04).
Similar results were obtained when accounting for beta-blocker discontinuation during follow-up.

Study Design

Type

Cohort (n=43,618)

Multicenter

Yes

Structured PICO

Population

43,618 patients with myocardial infarction (STEMI or NSTEMI) without heart failure or left ventricular systolic dysfunction (LVEF ≥50%) 1 year after hospitalization. Median age 64, 25.5% female, Swedish nationwide cohort.

Intervention

Beta-blocker therapy continued beyond 1 year after myocardial infarction

Comparator

No beta-blocker therapy beyond 1 year after myocardial infarction

Outcome

Composite of all-cause mortality, recurrent MI, unscheduled revascularisation, or hospitalisation for heart failurecomposite

Main Result

Effect estimate: HR 0.99 (95% CI 0.93 to 1.04)

Absolute Event Rate: 3.8% vs 4.9%

Limitations

Observational design limits causal inference.
Residual confounding may be present.
No data on health-related quality of life.
Observational design

Cite This Study

Ishak et al. (2023) conducted a cohort in Myocardial infarction (n=43,618). Beta-blockers vs. No beta-blockers was evaluated on Composite of all-cause mortality, recurrent MI, unscheduled revascularisation, and hospitalisation for heart failure (HR 0.99, 95% CI 0.93 to 1.04). Beta-blocker therapy beyond 1 year after myocardial infarction was not associated with improved cardiovascular outcomes (HR 0.99, 95% CI 0.93 to 1.04).

synapsesocial.com/papers/69697d6d8374bfe05cda346b https://doi.org/10.1136/heartjnl-2022-322115

Topics

Heart failure hospitalization Heart failure HFrEF treatment

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Implication

Should not yet change beta-blocker prescribing post-MI without HF/LVSD; challenges weak observational consensus and leaves open need for RCTs.

Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider