Common Heart Drug Questioned
Study: Beta Blockers May Be Overused
Beta-Blocker Study continued...
Those U.S. guidelines remain firmly in place, says William A. Zoghbi, MD, president of the American College of Cardiology.
Zoghbi notes that the Bangalore study is not a randomized clinical trial -- the gold standard of study design -- and by itself isn't enough evidence to change treatment guidelines.
Indeed, cardiologist David A. Friedman, MD, chief of heart failure services at North Shore-Long Island Jewish Hospital in Plainview, N.Y., says he's not going to change the way he treats heart attack and CAD patients.
"Beta-blockers have stood the test of time by decreasing [chest pain], by decreasing blood pressure and drive on the injured heart, and by letting the heart have time to heal," Friedman says. "I am not changing my practice, but this study and others have opened a new set of questions that need answers."
Who Needs Beta-Blockers, and for How Long?
Heart attack patients have one major question about beta-blockers.
"The most common question I get is, 'How long do I have to stay on the beta-blockers, doc?'" Friedman says. "We say, likely indefinitely, because you improve heart [function]."
Friedman notes that people differ widely in their response to beta-blockers. Zoghbi says doctors who prescribe beta-blockers must pay close attention to a patient's condition.
"The important thing is to make sure we control blood pressure," Zoghbi says.
Beta-blockers have major side effects, which can include diarrhea, stomach cramps, fatigue, depression, nightmares, and sexual dysfunction. A 2006 study found that one year after having a heart attack, only 45% of patients were still taking their beta-blockers.
"This is really where a discussion between a patient and the health care team is crucial," Zoghbi says. "Compliance is a significant issue. If patients are not tolerating a medication, we have to think of alternatives to control symptoms or decrease risk.”
The Bangalore study appears in the Oct. 3 issue of the Journal of the American Medical Association.