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Late-Breaking Science: How does beta-­blocker dose affect cardiovascular outcomes in patients after an MI?

Current guidelines do not recommend a specific beta-­blocker dose for patients who have experienced a myocardial infarction (MI). In addition, available data indicate that prescribed doses in clinical practice are below the targeted dose used in clinical trials. But does this matter? As presented today and published simultaneously in European Heart Journal: Acute Cardiovascular Care, Doctor Katarina Mars and teams at the Karolinska Institute (Stockholm, Sweden) and Uppsala University (Uppsala, Sweden) investigated whether beta-­blocker dose affected long­-term risk of cardiovascular events in post-MI patients in Sweden.

Pharmacology and Pharmacotherapy
Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care

Using the SWEDEHEART registry, 97,575 patients with a first-time MI who were discharged on beta-­blockers between 2006 and 2015 were studied. Around one-third (33,126) of patients were discharged on ≥50% of the target beta-­blocker dose used in previous randomised trials, while two-thirds (66.1%) received <50% of the target dose.

The investigators found that the primary composite endpoint of all-­cause death or reinfarction within 1 year of discharge was similar for patients treated with ≥50% of the target beta-­blocker dose compared with patients receiving <50% of the target dose (hazard ratio [HR] 1.03; 95% confidence interval [CI] 0.99–1.08). In fact, risk was higher with patients on ≥50% vs. <50% target beta-­blocker dose when stroke, atrial fibrillation or heart failure hospitalisation were added to the composite endpoint (HR 1.08; 95% CI 1.04–1.12).

When patients were followed for 5 years, similar results were obtained, with no apparent difference in cardiovascular outcomes with lower beta­-blocker doses. The results were also consistent across the subgroups studied, including patients who developed heart failure post-MI.

These interesting findings suggest that it is now time to further investigate the use of beta-­blockers after MI and that new trials are needed.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.