AUG 10, 2016 10:15 AM PDT

Lower dose of beta blockers may save lives

"We set out on a mission to show if you treat patients with the doses that were used in the clinical trials, they will do better," says Jeffrey Goldberger. "We expected to see patients treated with the lower doses to have worse survival. We were shocked to discover they survived just as well, and possibly even better." (Credit: C x 2/Flickr)

Heart attack patients treated with a substantially lower dosage of beta-blockers survive at the same—or in some cases an even better—rate than patients on higher doses.

In fact, a new study shows that patients who receive one-fourth of the original clinical trial dose had up to a 20 to 25 percent decrease in mortality compared to the full dose group.

About 90 percent of patients who have had a heart attack currently receive beta-blockers, a class of drug commonly prescribed to improve survival and prevent future heart attacks. Beta-blockers block the effects of adrenaline on the heart, reduce irregular heartbeat (arrhythmia), and help prevent heart failure.

No one was more surprised at the results than lead investigator Jeffrey Goldberger, professor of medicine in cardiology at Northwestern University. He launched the study when he discovered heart attack patients were being treated with much lower doses of beta-blockers than were used in clinical trials.

“I thought that was terrible quality of care,” says Goldberger. “We set out on a mission to show if you treat patients with the doses that were used in the clinical trials, they will do better. We expected to see patients treated with the lower doses to have worse survival. We were shocked to discover they survived just as well, and possibly even better.”

He says new research should be conducted to determine the most appropriate beta-blocker dose for individual patients to get the optimal benefit. The earlier clinical trials did not assess the effects of different doses.

Patients are treated with lower doses for a variety of reasons. There may be concern about possible side effects that may include fatigue, sexual dysfunction, and depression. In addition, when patients are started on conservative, low doses in the hospital after a heart attack, they return home so quickly, there is little time to adjust the dosage.

The new study, published in the Journal of the American College of Cardiology, examined data in a multicenter registry on 6,682 patients who had a heart attack. About 90 percent were receiving beta-blockers. All the patients on beta-blockers survived longer than those who did not receive the drugs. The raw, unadjusted data showed that of the people who received the full dose, 14.7 percent died within two years; of those receiving the half dose, 12.9 percent died; for the quarter dose, 9.5 percent died; and for the one-eighth dose, 11.5 percent died.

OBTAIN (Outcomes of Beta-Blocker Therapy After Myocardial Infarction) is an observational multicenter registry in which beta-blocker dosing information was collected in patients with an acute heart attack at participating centers to assess the effect of dose on survival.

“There is probably not one right dose for every single patient,” Goldberger says. “It doesn’t make sense that the same dose will work for an 80-year-old frail man who had a small heart attack as a burly 40-year-old man with a huge heart attack.

“We now need to figure out how to dose it in individual patients. That’s something no one has considered in the decades that we have been using this medication. This huge gap in knowledge has been completely unexplored. Since this is medicine we use in every single heart attack patient, we ought to figure out how to use it properly.”

The National Heart, Lung and Blood Institute at the National Institutes of Health supported the work.

Source: Northwestern University

This article was originally published on futurity.org.
About the Author
  • Futurity features the latest discoveries by scientists at top research universities in the US, UK, Canada, Europe, Asia, and Australia. The nonprofit site, which launched in 2009, is supported solely by its university partners (listed below) in an effort to share research news directly with the public.
You May Also Like
JAN 26, 2021
Genetics & Genomics
Why Only Some People With a Rare Mutation Get a Heart Condition
JAN 26, 2021
Why Only Some People With a Rare Mutation Get a Heart Condition
Scientists have found a way to explain why a heart condition called hypertrophic cardiomyopathy (HCM) can be so differen ...
FEB 18, 2021
Cardiology
Ongoing Heart Problems in Discharged COVID-19 Patients
FEB 18, 2021
Ongoing Heart Problems in Discharged COVID-19 Patients
About 50 percent of patients that are discharged from the hospital after recovering from a severe case of COVID-19 who e ...
APR 27, 2021
Cardiology
Excess Belly Weight Raises Heart Disease Risk Regardless of BMI
APR 27, 2021
Excess Belly Weight Raises Heart Disease Risk Regardless of BMI
Research has suggested that excess weight around the midsection of a person's body is a much better predictor of poor he ...
JUN 30, 2021
Clinical & Molecular DX
A Deep Learning Tool for Faster, Better Heart Disease Diagnoses
JUN 30, 2021
A Deep Learning Tool for Faster, Better Heart Disease Diagnoses
A new deep learning tool could help slash the time it takes to interpret cardiology scans to diagnose obstructive corona ...
JUL 12, 2021
Cardiology
Myocarditis in Children is Usually Due to a Virus
JUL 12, 2021
Myocarditis in Children is Usually Due to a Virus
The heart is a muscle, and the wall of the heart has several layers. In a condition called myocarditis, the middle layer ...
AUG 29, 2021
Cardiology
Bystanders Can Help Cardiac Arrest Victims Survive
AUG 29, 2021
Bystanders Can Help Cardiac Arrest Victims Survive
New research has indicated that if someone is having a heart attack, a swift response from anyone that might be nearby c ...
Loading Comments...