Adherence to Beta-Blockers and Long-Term Risk of Heart Failure and Mortality After a Myocardial Infarction
Key result
Beta-blocker adherence post-AMI is linked to ~17% lower risk of HF readmission or death.
- HR 0.83
- 95% CI 0.78-0.89
- P<0.001
- n=38,608
Why the study?
The study investigated the association between adherence to beta-blocker treatment after a first acute myocardial infarction and long-term risk of heart failure and death.
Does adherence to beta-blockers reduce all-cause mortality and HF readmission/death in patients surviving 1 year after a first AMI?
Population
38 608 1-year survivors of a first AMI in a nationwide Swedish registry
Comparison
Beta-blocker adherence (proportion of days covered ≥80%) vs non-adherence
Design
Nationwide registry-based cohort study
Follow-up
4 years
Authors
Discussion
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Member takes
Implication
May support beta-blocker adherence counseling after AMI; leaves open causal confirmation in randomized trials.
Study Design
Type
Cohort (n=38,608)
Multicenter
Yes
Structured PICO
Does adherence to beta-blockers reduce all-cause mortality and HF readmission/death in patients surviving 1 year after a first AMI?
P
Population
38,608 patients who survived 1 year after a first acute myocardial infarction (AMI), excluding those with previous HF, unknown LVEF, or who died during the first year.
I
Intervention
Adherence to prescribed beta-blockers (proportion of days covered ≥80%) during the first year after the index event
C
Comparator
Non-adherence to beta-blockers (proportion of days covered <80%)
O
Outcome
All-cause mortality and composite of HF readmission/death during the subsequent 4 years of follow upcomposite
Main Result
Effect estimate: HR 0.83 (95% CI 0.78-0.89)
p-value: p=<0.001
Adherence to beta-blockers in the first year after a first AMI is associated with improved long-term survival and reduced heart failure readmission, though benefits are less certain in patients with normal ejection fraction.
Limitations
- Uncertainty remains regarding the benefit for patients with heart failure with normal ejection fraction and normal ejection fraction without heart failure.
Cite This Study
Desta et al. (2020) conducted a cohort in First acute myocardial infarction (AMI) (n=38,608). Adherence to beta-blockers (≥80% proportion of days covered) vs. Non-adherence to beta-blockers (<80% proportion of days covered) was evaluated on Composite of HF readmission or death (HR 0.83, 95% CI 0.78-0.89, p=<0.001). Adherence to beta-blockers in the first year after a first AMI was associated with a lower risk of heart failure readmission or death (HR 0.83; 95% CI 0.78-0.89; P<0.001).