Should beta-blockers be recommended after myocardial infarction when left ventricular ejection fraction is normal?

For many years, clinical practice guidelines have recommended beta-blockers after myocardial infarction for all patients without a contraindication. In this issue of Heart, this recommendation is questioned by a propensity adjusted analysis from the SWEDEHEART registry which found no association between long-term beta-blocker use and mortality or major cardiovascular events in 43 618 patients with previous myocardial infarction who did not have heart failure or left ventricular (LV) systolic dysfunction.1 Many clinical trials have evaluated whether beta-blockers improve clinical outcomes after myocardial infarction, but most were undertaken more than 25 years ago. In a meta-analysis published in 1999,2 randomised clinical trials that evaluated acute, short-term treatment with a beta-blocker included 29 260 patients and 3062 (10.5%) deaths. On beta-blockers, there was no significant reduction in the pooled odds ratio (OR) for death (0.96, 95% CI 0.85 to 1.08). However, for trials that evaluated longer term beta-blocker treatment,...
Source: Heart - Category: Cardiology Authors: Tags: Press releases Editorials Source Type: research