BY TIM BONFIELD
The Cincinnati Enquirer
Two new studies indicate that thousands of heart attack victims -- even the oldest and sickest patients -- would live much longer if doctors were more willing to prescribe beta blockers when they leave the hospital.
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Among diabetics, Dr. Stephen Gottlieb's study found beta blockers lowered the risk of death from 27 percent to 17 percent; for patients with lung disease, from 28 percent to 17 percent; and for those with congestive heart failure, from 29 percent to 17 percent. |
Strong new support for an old cardiac medication emerged this week from studies published in two of the nation's top medical journals. And several Tristate cardiologists said it's about time.
"The benefits of beta blockers have been known for 25 years," said Dr. Pete Caples, a Cincinnati-area cardiologist. "The criticisms are correct. They have been underutilized. But in the past year, we've been pushing them a lot more."
Beta blockers -- developed in the 1960s -- help prevent second heart attacks by blocking the function of "beta-adrenergic receptors," which are cells in the heart and other organs that absorb adrenaline. Beta blockers help reduce the heart's workload and maintain a steady beat.
However, doctors say beta blockers often cause side effects including fatigue, sensitivity to cold, lightheadedness, depression, loss of mental sharpness and decreased sexual ability.
Past studies have reported that beta blockers can reduce mortality in the first two years after a heart attack by as much as 40 percent. But the new studies reveal many patients still are not getting the drugs:
A study of Medicare patients, published today in the Journal of the American Medical Association (JAMA), reports that, on average, only 50 percent of "ideal" candidates get beta blockers after a heart attack. Moreover, prescription rates range widely by state, from 30.3 percent in Mississippi to 77.1 percent in Connecticut.
A study in Thursday's New England Journal of Medicine reports that many non-ideal patients -- such as people over 75 or patients with heart failure or diabetes -- also survive longer when they used beta blockers. In fact, the report estimates that more than 19,000 patients a year could have been kept alive in past years had beta blockers been more widely prescribed.
This year, an estimated 1.1 million Americans will suffer a heart attack, and one-third of them will die, according to the American Heart Association.
Many experts consider beta blockers to be the first-line treatment to prevent second heart attacks. Over the years, however, many doctors have avoided prescribing beta blockers in favor of other, often less-effective drugs such as calcium channel blockers and aspirin.
"A lot of doctors were taught that a lot of people cannot use beta blockers," said Cincinnati cardiologist Dr. Joe Hackworth. "In the past year or two, cardiologists have been using them in higher doses for more patients. But a lot of primary-care doctors probably haven't gotten the message yet."
Overall, about one-third of all surviving heart attack victims take beta blockers.
The New England Journal study, based on the medical records of 201,752 Medicare patients, found that the benefits of beta blockers appear to outweigh possible hazards.
"There is no doubt in my mind that this incredibly inexpensive treatment (as little as $5 a month) can be tolerated by the vast majority of patients and can improve survival in patients with almost any other disease," said Dr. Stephen S. Gottlieb of the University of Maryland, who directed the study.
Reaction from national cardiac experts was largely supportive of the findings, but not unanimous.
"I think this paper will have a significant impact," said Dr. Valentin Fuster, president of the American Heart Association. "It will awaken many physicians to the fact of beta blockers." However, Dr. Harlan M. Krumholz of the Yale School of Medicine -- and lead author of the JAMA study -- said doctors should remain cautious about contraindications, or reasons not to use the drug.
"We shouldn't run to treat all the people with all these contraindications without considering the gradations" of severity of their conditions, he said.
Cardiologists said they expect more patients to start asking whether they should be taking beta blockers. Some recent heart attack survivors may benefit from starting or switching to beta blockers. However, many patients were prescribed other drugs because they already suffered side effects from beta blockers, doctors said.
The Associated Press contributed to this report.
