beta blockers (long-term use post myocardial infarction)
Last edited 08/2020
- long-term use of beta-blockers reduces mortality in patients who have had a myocardial infarction (evidence from a meta-analysis of randomised controlled trials)
- a beta blocker is recommended for all people following myocardial infarction unless there are contraindications. The evidence for beta blockade is strongest for those people with a large myocardial infarction, or infarction complicated by heart failure or ventricular arrhythmias (1)
- a systematic review concluded that, with a moderate-quality of evidence, beta-blockers for suspected or diagnosed acute myocardial infarction probably reduce the short-term risk of myocardial infarction during follow up and the long-term risk of all-cause mortality and cardiovascular mortality. Nevertheless, it is most likely that beta-blockers have little or no effect on the short-term risk of all-cause mortality and cardiovascular mortality (2)
- what about if a patient has normal left ventricular function:
- ICE have issued guidance as to the use of beta blockers post myocardial
infarction (3):
- continue a beta-blocker indefinitely in people with left ventricular
systolic dysfunction
- offer all people who have had an MI more than 12 months ago, who
have left ventricular systolic dysfunction, a beta-blocker whether
or not they have symptoms
- do not offer people without left ventricular systolic dysfunction or heart failure, who have had an MI more than 12 months ago, treatment with a beta-blocker unless there is an additional clinical indication for a beta-blocker
- continue a beta-blocker indefinitely in people with left ventricular
systolic dysfunction
- ICE have issued guidance as to the use of beta blockers post myocardial
infarction (3):
Reference:
- BS2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91 (Supp 5)
- Safi S et al. Beta-blockers for suspected or diagnosed acute myocardial infarction. Cochrane Database Syst. Rev. December 2019.
- NICE (2013). Secondary prevention in primary and secondary care for patients following a myocardial infarction