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Heart Disease (Expert Forum)
Beta Blockers for ALL Heart Attack Survivors?
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Beta Blockers for ALL Heart Attack Survivors?
by Cindy-T, Aug 20, 1998 12:00AM
Dear Doctors:
First, thank you so very much for this WONDERFUL forum!
My question has to do with the latest study appearing in the New England Journal of Medicine. The article states that "beta blockers should be part of the standard care of every heart attack patient, regardless of medical history." I am curious as to what the opinion is at the #1 Heart Center (Cleveland Clinic)?
Again, thank you so much for all that you continue to do to reach out to patients!
Doctor's Answer
by CCF Cardio MD - MTR, Aug 20, 1998 12:00AM
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Dear Cindy, thank you for your question. I read the article you mentioned with great interest because at Cleveland Clinic, we are always trying to educate other physicians about what the proper care for cardiac patients should be. I wholeheartedly agree that almost all patients who have a heart attack (MI) should be treated initially and long-term with beta blockers. We commonly initiate beta blocker therapy in the hospital and continue these medications long-term after hospital discharge. The original studies performed in the early 1980's showed a dramatic reduction in mortality with beta blockers for MI patients and subsequent studies have confirmed that tremendous survival advantage. Beta blockers are thought to decrease the incidence of fatal rhythm disturbances following a MI and to decrease the oxygen demand of the heart as it is recovering from the insult of the MI. In the study mentioned, Medicare patients (all > 65 years old) were treated with beta blockers at rates much lower than we would like to see now. Also, the sickest patients (who stand to benefit the most from beta blockers) were treated with beta blockers at even lower rates. Our recommendations are that all patients with a MI should be considered for treatment with beta blockers. Contraindications to beta blocker use include cardiogenic shock, very low blood pressure, slow heart rhythm disturbances, active bronchospasm (wheezing - caused by asthma or emphysema), and known allergies or intolerance to beta blockers. Age certainly is not a contraindication. Additional life-saving therapies that should be used for MI patients include aspirin, lipid lowering medications called statins (if the LDL cholesterol is > 100 mg/dl), and ACE inhibitors (if the left ventricular function is damaged). Thus, I hope this response is informative. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.
Dear Cindy, thank you for your question. I read the article you mentioned with great interest because at Cleveland Clinic, we are always trying to educate other physicians about what the proper care for cardiac patients should be. I wholeheartedly agree that almost all patients who have a heart attack (MI) should be treated initially and long-term with beta blockers. We commonly initiate beta blocker therapy in the hospital and continue these medications long-term after hospital discharge. The original studies performed in the early 1980's showed a dramatic reduction in mortality with beta blockers for MI patients and subsequent studies have confirmed that tremendous survival advantage. Beta blockers are thought to decrease the incidence of fatal rhythm disturbances following a MI and to decrease the oxygen demand of the heart as it is recovering from the insult of the MI. In the study mentioned, Medicare patients (all > 65 years old) were treated with beta blockers at rates much lower than we would like to see now. Also, the sickest patients (who stand to benefit the most from beta blockers) were treated with beta blockers at even lower rates. Our recommendations are that all patients with a MI should be considered for treatment with beta blockers. Contraindications to beta blocker use include cardiogenic shock, very low blood pressure, slow heart rhythm disturbances, active bronchospasm (wheezing - caused by asthma or emphysema), and known allergies or intolerance to beta blockers. Age certainly is not a contraindication. Additional life-saving therapies that should be used for MI patients include aspirin, lipid lowering medications called statins (if the LDL cholesterol is > 100 mg/dl), and ACE inhibitors (if the left ventricular function is damaged). Thus, I hope this response is informative. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.
