Key result
Beta-blockers modestly increase depressive symptoms at 6-10 weeks among MI patients with preserved LVEF.
Why the study?
Following findings from REDUCE-AMI showing no clinical benefit of beta-blockers after MI with preserved LVEF, this sub-study evaluated the effects of beta-blockers on symptoms of anxiety and depression.
Does beta-blocker treatment increase symptoms of anxiety and depression in patients with myocardial infarction and preserved left ventricular function?
RCT (n=806)
Open-label
1:1 ratio with permuted blocks
Yes
Does beta-blocker treatment increase symptoms of anxiety and depression in patients with myocardial infarction and preserved left ventricular function?
Effect estimate: β 0.48 (95% CI 0.09-0.86)
p-value: p=0.015
In patients with myocardial infarction and preserved LVEF, routine initiation of beta-blocker treatment led to a modest increase in self-reported depressive symptoms, highlighting a potential risk that should be considered in clinical practice.
May warrant monitoring depressive symptoms when starting beta-blockers post-MI with preserved LVEF; extends evidence on neuropsychiatric effects in contemporary RCTs.
AIMS: Among patients with myocardial infarction (MI) with preserved left ventricular ejection fraction (LVEF), the REDUCE-AMI trial did not demonstrate a benefit of beta-blocker vs. no beta-blocker treatment on all-cause mortality and recurrent myocardial infarction. The aim of this pre-specified sub-study was to investigate effects of beta-blockers on self-reported symptoms of anxiety and depression. METHODS AND RESULTS: In this parallel-group, open-label, registry-based randomized trial, assessments with the Hospital Anxiety and Depression Scale were obtained at hospitalization and two follow-up points (6-10 weeks and 12-14 months) after MI. Analyses were based on the intention-to-treat principle using linear mixed models, calculating both short- and long-term effects. From August 2018 through June 2022, 806 patients were enrolled. At baseline, 27% of patients were possible cases of anxiety (m, 5.6; SD, 3.9) and 14% were possible cases of depression (m, 3.9; SD, 3.2). Beta-blocker treatment had a negative effect on depressive symptoms at both follow-ups 1 (β = 0.48; 95% CI 09-0.86; P = 0.015) and 2 (β = 0.41; 95% CI = 0.01-0.81; P = 0.047), but no effect on anxiety. CONCLUSION: Beta-blocker treatment led to a modest increase in depressive symptoms among MI patients with preserved LVEF. This observed effect was most pronounced in individuals with prior beta-blocker treatment. In routine initiation and continuation of beta-blocker treatment, a risk of slightly increased depressive symptoms should be considered.
No takes yet. Share an insight, caveat, or question.
Leissner et al. (2024) conducted an RCT in Myocardial infarction with preserved left ventricular ejection fraction (n=806). Beta-blockers (metoprolol or bisoprolol) vs. No beta-blocker was evaluated on Depressive symptoms (HADS-Depression score) at 6-10 weeks (β 0.48, 95% CI 0.09-0.86, p=0.015). Beta-blocker treatment led to a modest increase in depressive symptoms (β 0.48) at 6-10 weeks among myocardial infarction patients with preserved left ventricular ejection fraction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: