Among stable, relatively low-risk patients who had previously suffered a heart attack, discontinuing beta-blockers after at least one year was found to be non-inferior, or comparable, to continuing beta-blockers in terms of death, another heart attack or hospitalization for heart failure, according to a study presented at the American College of Cardiology's Annual Scientific Session (ACC.26).
Beta-blockers, which lower heart rate and blood pressure by inhibiting adrenaline and other hormones, have long been a mainstay of treatment to reduce the likelihood of subsequent cardiac events following a heart attack. However, many studies confirming their benefits were conducted decades ago, when procedures and medications for secondary prevention were more limited than they are today. More recent studies suggest the benefits of beta-blockers may vary depending on the overall health of a patient's heart.
In appropriately selected patients who survived a heart attack and do not have heart failure or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary. In practice, for stable patients who are several years out from a heart attack, discontinuation can be considered through shared decision-making and with monitoring of blood pressure and heart rate. For patients with beta-blocker-related side effects - fatigue, dizziness, bradycardia, hypotension - the case for discontinuation is even stronger."
Joo-Yong Hahn, MD, cardiologist at Samsung Medical Center in Seoul, South Korea, and study's senior author
The study evaluated 2,540 patients at 26 sites in South Korea between 2021 and 2024 who had no subsequent cardiac events after taking beta-blockers for at least one year following a heart attack. Participants' average age was 63 years and 87% were men. At a median of 3.5 years following randomization, the primary endpoint - a composite of all-cause death, recurrent heart attack or heart failure hospitalization - occurred in 7.2% of those who discontinued beta-blockers and 9% of those who continued taking the medication. The results met the threshold for non-inferiority because of a lower rate of this composite endpoint in the group that stopped taking beta-blockers.
Discontinuation of beta-blockers was also found to be similar for secondary endpoints, including each of the components of the primary composite endpoint, new-onset atrial fibrillation, unfavorable changes in left ventricular function, changes in quality of life and serious adverse events.
"In current practice - where revascularization rates are high and secondary prevention is strong - we expected that the incremental benefit of continuing beta-blockers indefinitely in stable patients might be small," Hahn said. "We found that discontinuation did not worsen major outcomes, cardiac function or quality of life in this selected stable population."
Since most study participants had been taking beta-blockers for several years before discontinuing, Hahn said that the results may not apply to patients who have been taking beta-blockers for a shorter amount of time. The study also does not definitively establish the earliest timepoint at which it is safe to stop taking beta-blockers.
The results were generally consistent across prespecified subgroups. However, women and patients with mildly reduced left ventricular ejection fraction made up a small proportion of the trial population, limiting the interpretation of results for these subgroups. In addition, the study was conducted only in South Korea, potentially limiting its generalizability to other areas of the world.
Hahn said future studies could help to clarify whether and when it is safe to discontinue beta-blockers among higher-risk groups, women and those with mildly reduced left ventricular ejection fraction and to better define the optimal timing of discontinuation. Pooled analyses across contemporary randomized trials could provide additional insights and help guide practice decisions. The researchers also plan to conduct further analyses to assess potential differences in health care costs.
The study was funded by the Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare of the Republic of Korea.
This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.
Hahn will present the study, "Discontinuation of β-blocker Therapy in Stabilized Patients after Acute Myocardial Infarction," on Monday, March 30, at 8:30 a.m. CT / 13:30 UTC in the Main Tent, Great Hall.
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