beta Blocker treatment and other prognostic variables in patients with clinical evidence of heart failure after acute myocardial infarction: evidence from the AIRE study

Abstract

Objectives-To examine clinical outcomes associated with optional blockade in a population of patients with evidence of heart failure after myocardial infarction. Design and patients-Data from the acute infarction ramipril eYcacy (AIRE) study were analysed retrospectively. At baseline 22.3% of the patients were receiving a blocker. To minimise confounding, blocker and diuretic treatments, presence of clinical signs of heart failure, left ventricular ejection fraction, and 16 other baseline clinical variables were simultaneously entered in a multivariate Cox regression model. In addition, the same analysis was repeated separately within a high and a low risk group of patients, as defined according to the need for diuretic treatment. Results-Blocker treatment was an independent predictor of reduced risk of total mortality (hazard ratio 0.66, 95% confidence interval (CI) 0.48 to 0.90) and progression to severe heart failure (0.58, 95% CI 0.40 to 0.83) for the entire study population. There were similar findings in high risk patients requiring diuretics (0.59, 95% CI 0.40 to 0.86; and 0.58, 95% CI 0.38 to 0.89). Conclusions-Blocker treatment is associated with improved outcomes in patients with clinical evidence of mild to moderate heart failure after myocardial infarction. Most importantly, high risk patients with persistent heart failure appear to benefit at least as much as lower risk patients with transient heart failure. (Heart 1999;81:25-32)

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

“…Patients who are prescribed beta-blockers in hospital are more likely to be on treatment in the intermediate follow-up and are more likely to be at target doses without an increase in side effects or adverse events (117). This supports a strategy of beta-blocker administration before hospital discharge in stabilized patients (117)(118)(119)(120)(121)(122)(123)(124)(125)(126).…”

“…There is no other subgroup of patients that has been shown to experience increased adverse events or side effects (117)(118)(119)(120)(121)(122)(123)(124)(125)(126).…”

A systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of aldosterone antagonists for postmyocardial infarction heart failure

“…85 Prior to the standard use of thrombolytics, ACE inhibitors and aspirin, beta-blockers produced a 20-30% reduction in mortality in postMI patients with LVSD; however, it was unclear whether this benefit would be sustained after the introduction of these treatments. 83,93 Retrospective analyses showed continued significant reductions in mortality and progression to severe HF in patients receiving beta-blockers alongside captopril 94 or ramipril 95 compared with those not receiving beta-blockers. A more recent prospective study showed carvedilol to reduce all-cause mortality by 23%, CV mortality by 25% and non-fatal MI by 41%; of the 1959 patients included, 98% were on ACE inhibitors, 86% were on aspirin and 45% received reperfusion treatment.…”

Percutaneous Coronary Intervention “Dominates” Coronary Artery Bypass Graft Surgery for High-Risk Patients

“…We now know that these patients benefit from ␤-blocker therapy because subsequent trials and secondary analyses have shown us the benefit in higher-risk groups. 8 The early randomized trials of PCI versus medical therapy examined patients with single-vessel coronary artery disease without left ventricular systolic dysfunction. 9 We now know from AWESOME and TIME that higher-risk patients can be treated safely with medical or invasive strategy, perhaps because our medications, techniques, and instrumentation have improved.…”