Beta-blocker treatment after myocardial infarction reduced the odds of death by 22.6% (95% CI 11-32.3%), with absolute benefits appearing greater in patients with heart failure.
Meta-Analysis
Effect estimate: 22.6% reduction in odds (95% CI 11-32.3% reduction)
Abstract Background The great majority of post-infarction studies of beta-blockers were conducted in an era when these agents were widely held to be contra-indicated for the management of heart failure. We now know that beta-blockers are highly effective for the management of patients with chronic stable heart failure. However, there remains uncertainty about their role in the setting of post-infarction heart failure and ventricular dysfunction. Aim the primary objective in this paper, was to investigate the extent to which heart failure or evidence of major cardiac dysfunction influenced outcome in previous trials of beta-blockers in heart failure after myocardial infarction. Methods We assessed the extent to which the inclusion of patients with heart failure or major cardiac dysfunction influenced outcome in randomised trials of long-term use of beta-blockade after myocardial infarction. The primary analysis was to assess the extent to which the proportion of patients included in each trial with heart failure influenced the relative odds of all-cause mortality in the trials. All randomised trials without crossover with treatment lasting more than one month and with 50 or more patients were considered. All those that provided information on the proportion of patients with heart failure or major cardiac dysfunction in the original or subsequent articles were included in the analysis. Results Overall treatment with a beta-blocker was associated with a 22.6% reduction in the odds of death (95% C1 11-32.3%). There were very few data on the effects of beta-blockers after myocardial infarction in patients with documented left ventricular systolic dysfunction. In the analysis that included heart failure as a factor, treatment with a beta-blocker was associated with a non-significant interaction with the presence of heart failure. However, because the group including heart failure patients were at higher risk, the absolute benefit of treatment with beta-blockers appeared greater in this group. Conclusions This analysis suggests that the relative benefit of beta-blockers on mortality after a myocardial infarction is similar in the presence or absence of heart failure but that the absolute benefit may be greater in the former. However, as current clinical practice has changed radically from the time when the majority of these trials were conducted, further trial evidence would be desirable.
Houghton et al. (Fri,) conducted a meta-analysis in Myocardial infarction with heart failure or major cardiac dysfunction. Beta-blockers vs. Control was evaluated on All-cause mortality (22.6% reduction in odds, 95% CI 11-32.3% reduction). Beta-blocker treatment after myocardial infarction reduced the odds of death by 22.6% (95% CI 11-32.3%), with absolute benefits appearing greater in patients with heart failure.