Recent findings from a sub-study conducted at Uppsala University indicate that the routine prescription of beta blockers for heart attack patients without heart failure may carry unintended psychological side effects, particularly depression. This study, which extends earlier research conducted in Sweden, challenges the longstanding practice of administering beta blockers to all heart attack survivors, regardless of their heart’s pumping function.
Questioning Routine Beta Blocker Use
For decades, beta blockers have been a cornerstone in the treatment of heart attack patients, largely due to their ability to block adrenaline’s effects on the heart. These drugs are intended to reduce heart rate and lower blood pressure, thereby minimizing the risk of a second heart attack. However, as new treatments continue to evolve, the necessity of beta blockers for patients with normal cardiac function after a heart attack is being called into question. This is particularly relevant for those whose hearts maintain normal pumping ability and do not exhibit signs of heart failure.
A comprehensive national study conducted in Sweden earlier this year examined the effectiveness of beta blockers in preventing relapse or death among heart attack survivors. The findings, published in a reputable medical journal, revealed that patients who were prescribed beta blockers did not show a significant reduction in the risk of a second heart attack or mortality compared to those who were not on the medication. These results have prompted further investigation into the potential drawbacks of beta blockers, especially their psychological impact on patients.
The Uppsala Sub-Study: Exploring Psychological Side Effects
Building on the findings of the national study, researcher Dr. Leissner and his team at Uppsala University conducted a sub-study between 2018 and 2023. This research focused on 806 heart attack patients who did not suffer from heart failure. The participants were divided into two groups: one half received beta blockers, while the other half did not. Notably, approximately 100 participants had already been using beta blockers prior to the study’s commencement.
The results showed that patients on beta blockers, especially those who had been taking the medication long-term, exhibited more severe symptoms of depression compared to those who were not on the drug. This correlation between beta blockers and increased depressive symptoms aligns with previous research and clinical observations, which have suggested that beta blockers may contribute to mood disorders, sleep disturbances, and even nightmares.
We found that beta blockers led to slightly higher levels of depression symptoms in patients who had had a heart attack but were not suffering from heart failure. At the same time, beta blockers have no life-sustaining function for this group of patients
Philip Leissner, doctoral student in cardiac psychology and study's first
The Swedish studies collectively highlight the importance of personalized treatment strategies, urging healthcare professionals to consider the mental health implications of medications prescribed to heart attack survivors. Further research may be needed to fully understand the long-term impact of beta blockers on mental health and to develop guidelines that protect patients from unnecessary side effects.
Philip Leissner, doctoral student in cardiac psychology and study's first
Implications for Heart Attack Treatment
The findings from this sub-study add weight to the growing call for a re-evaluation of the widespread use of beta blockers among heart attack patients without heart failure. According to Dr. Leissner, while beta blockers have traditionally been prescribed to nearly all heart attack patients, the evidence supporting their efficacy in individuals with normal cardiac function is no longer as robust. This raises important questions about whether the risks, particularly the potential for developing depression, outweigh the benefits for this subgroup of patients.
“Many physicians have historically prescribed beta blockers even for patients without heart failure. However, given the weaker evidence supporting their use in these cases, it is time to reconsider this approach. If beta blockers are not making a meaningful difference to the heart’s recovery, patients may be exposed to unnecessary risks, including a higher likelihood of depression.”
Moving Forward: A Shift in Treatment Guidelines?
These findings suggest that a shift in treatment protocols may be warranted, particularly for heart attack patients whose heart functions remain normal post-event. As new therapies become available, the role of beta blockers in managing heart health needs to be reassessed to ensure that patients receive the most effective and least harmful care possible.
References:
1. https://www.nejm.org/doi/full/10.1056/NEJMoa2401479
2. https://pubmed.ncbi.nlm.nih.gov/39422765/
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