Chapel Hill, NC—Heart attack survivors might not need to take beta-blockers if they are following an ACE inhibitors/statin regimen.

That’s according to a new study published recently in the Journal of the American College of Cardiology. Current clinical guidelines call for the lifelong use of all three drugs by patients after acute myocardial infarction (AMI).

University of North Carolina–led researchers investigated the effect of tradeoffs in adherence to ACE inhibitors/angiotensin II receptor blockers (ARB), beta-blockers, and statins on survival among older patients who survived AMI.

To accomplish that, the study authors identified 90,869 Medicare beneficiaries aged 65 years and older who had prescriptions for ACE inhibitors/ARBs, beta-blockers, and statins, and who survived more than 180 days after AMI hospitalization in 2008 to 2010.

For the study, adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge, while mortality follow-up extended up to 18 months after the investigation period.

Results indicate that only 49% of the patients adhered (PDC ≥80%) to all three therapies. Compared with being adherent to all three therapies, multivariable-adjusted hazard ratios for mortality were:
• 1.12 for being adherent to ACE inhibitors/ARBs and beta-blockers only
• 0.98 for ACEI/ARBs and statins only
• 1.17 for beta-blockers and statins only
• 1.19 for ACE inhibitors/ARBs only
• 1.32 for beta-blockers only
• 1.26 for statins only, and
• 1.65 for being completely nonadherent to all therapies.

“Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all three therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE inhibitors/ARBs,” researchers write. “Nonadherence to ACE inhibitors/ARBs and/or statins was associated with higher mortality.”

“The problem with this three-drug regimen is that it is difficult for people to take their medications as they are supposed to in the long term,” explained senior author Gang Fang, PharmD, MS, PhD, an assistant professor at the UNC Eshelman School of Pharmacy. “This is especially true of older patients who are likely to already be taking many different drugs.”

Fang added that patients in the study who had diabetes, dementia, or both had higher mortality rates when taking beta blockers as prescribed. Further research is warranted, he said, advising that more caution would be prudent in prescribing beta-blockers for elderly heart-attack survivors with diabetes or dementia.

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