ACUTE coronary syndrome (ACS) patients who discontinue beta-blockers prematurely risk dramatically increased rates of death and morbidity according to Portuguese researchers. The authors believe their study demonstrates an urgent need to improve patient education about compliance with cardiac drugs.
Current clinical guidelines emphasise the importance of beta-blockers after ACS, stressing that they should be prescribed to all patients, unless they have contra-indications, such as severe asthma, chronic pulmonary obstructive disease or some Brady arrhythmias.
Presenting author, Dr Pedro Monteiro, of the Cardiology Department at Coimbra University (Coimbra, Portugal), said: “Despite what’s written in clinical guidelines, many patients with ACS abandon the medication prescribed after hospital discharge for a variety of reasons. This may be due to side effects (such as bradycardia or decreased libido), economic reasons or because they have failed to understand the importance of the medication. We wanted to know the ‘real world’ impact of this decision on patient prognosis.”
The Portuguese team conducted a retrospective analysis of the Portuguese Registry on Acute Coronary Syndromes, a nationwide database containing information from 14,848 patients admitted since 2002 for ACS. Of this population, 2,869 patients had been discharged on beta-blockers with six months follow-up data available; 2,373 people were still taking beta-blockers at the six-month follow-up and 496 were not.
At six months, mortality was 20.2% among people who had stopped taking beta-blockers, compared to 0.4% among those that continued to take them (p<0.001). Morbidity was 47.5% for those that had quit, compared to 21.5% for that had not (p<0.001). Higher rates of re-infarction, stroke and non-elective coronary surgery could account for the difference in morbidity.
The investigators admitted that they were surprised by the extent of the difference in mortality and morbidity between the two groups. “This study clearly shows that, for the patient admitted for an ACS, it is vital to comply with all the prescribed medications indefinitely,” said Dr Monteiro.
He added that clinicians should explain to their patients that the medication they have prescribed must be accurately taken if they are to improve their long-term outcome. “Further explanations need to be offered to the patient’s family and general practitioner because both are important in helping patients to comply. Patients should also be asked to get in touch with their physician if they have any doubts regarding their medication, or if they develop side-effects, instead of taking it upon themselves to stop medication,” he concluded.