Key result
Taking ≥50% target β-blocker dose post-MI is linked to slightly lower EQ-VAS scores versus <50%.
Why the study?
Beta-blockers are routinely administered following myocardial infarction, but their potential effect on health-related quality of life is not entirely understood.
Does ≥50% target β-blocker dose improve health-related quality of life compared to <50% target dose in patients following first-time myocardial infarction?
Observational (n=35,612)
Yes
Does ≥50% target β-blocker dose improve health-related quality of life compared to <50% target dose in patients following first-time myocardial infarction?
Effect estimate: Difference -0.87 (95% CI -1.23, -0.46)
p-value: p=< .001
Higher doses of beta-blockers post-MI do not improve health-related quality of life and may be associated with slightly lower self-rated health scores, though the clinical significance is likely low.
Higher β-blocker doses post-MI do not improve HRQoL; hypothesis-generating and should not yet change practice.
BACKGROUND: β-blockers are routinely administered to patients following myocardial infarction (MI), yet their potential effect on health-related quality of life (HRQoL) is not entirely understood. We investigated the relationship between two different doses of β-blockers with HRQoL following MI. METHODS AND RESULTS: This nationwide observational study used Swedish national registries to collate sociodemographic, clinical, medication, and HRQoL {the latter operationalized using EuroQol [European Quality of Life Five Dimensions Questionnaire (EQ-5D)]}. Estimates at 6-10 weeks and 12-14 months post-MI follow-up from pooled linear and logistic models were calculated after multiple imputation. We identified 35 612 patients with first-time MI, discharged with β-blockers, and enrolled in cardiac rehabilitation between 2006 and 2015. Upon discharge, patients were either dispensed <50% [24 082 (67.6%)] or ≥50% [11 530 (32.4%)] of the target dosage, as defined in previous trials. After adjusting for pre-defined covariates, neither the EQ-5D Index nor the Emotional Distress items were statistically different between groups. The EQ-VAS score was significantly lower in patients treated with ≥50% target β-blocker dose than those treated with <50% of the target dose [-0.87 [-1.23, -0.46], P < .001]. Results were similar at the 12-month follow-up and across sub-groups separated by sex and age. CONCLUSION: No difference in HRQoL was found among patients taking <50% vs. ≥50% of the target β-blocker dose, except for the EQ-VAS in which higher scores were reported in those taking a lower dose. The clinical meaningfulness of this statistical significance is likely low.
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Humphries et al. (2022) conducted an observational in first-time myocardial infarction (n=35,612). β-blockers vs. <50% of target dosage was evaluated on Health-related quality of life (EQ-5D Index, Emotional Distress, EQ-VAS score) (Difference -0.87, 95% CI -1.23, -0.46, p=< .001). Taking ≥50% of the target β-blocker dose post-MI was associated with a slightly lower EQ-VAS score compared to <50% dose (difference -0.87; 95% CI -1.23, -0.46; P<0.001), with no difference in EQ-5D.
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