A recent research study found 4.3% reduction of deaths and curtailment in heart failure hospitalization cases while analyzing the efficacy of β blockers, blood pressure lowering drugs, in cardiac patients who suffered from reduced blood ejection fraction (HFrEF). The study was published in the BMJ journal this Wednesday.
It was a meta-analysis covering data acquired from 13,833 individual patient records from 11 trials rather than considering different intervention studies as a whole. The main objective of the study was to analyze the effect of age and gender on the efficacy and acceptability (continuous use) of the beta-blocker drugs in the patients with heart failure who experience reduced ejection fraction ultimately resulting in death or hospitalization.
The findings of the analysis conducted the by the help of ‘cox proportional hazards model’ showed promising results by the use of β blocker drugs and showed significant reduction in the cases of death along with less hospitalization incidences. The subjects selected for the analysis had a median age 64 and 24% of which were women, the overall age of the patients ranged between 40-85 and the left ventricular ejection fraction being less than 0.45. It was found that the positive outcomes associated with the use of these drugs were independent of the age and gender i.e., the results of the analysis of the placebo trial conducted for checking the efficacy of the beta-blockers in relation to age demonstrated positive effects irrespective of the age, in all age groups included in the study and there was no significant interaction found when age was modeled continuously (P=0.1).
The absolute death reduction of 4.3% was observed during a follow-up period of 1.3 years; however, 16% of patients died during the study. Furthermore, the incidences of hospitalization due to heart failure were found to be significantly reduced by β blockers use in adult patients, with interval value (P=0.05). On the other hand, the conclusive results did not suggest reduction in fatal and non-fatal myocardial infarction or stroke incidences, associated with the use of β blockers in any age group.
Study’s lead author Dipak Kotecha, who is a clinician scientist in cardiovascular medicine, UK, affirmed the positive outcomes of the study for the patients with HFrEF due to sinus rhythm, irrespective of the gender and age. He endorsed the β blockers capability to reduce mortality and heart failure related hospitalization in such patients.
Outcomes of the analysis also pointed out the fact that the beta drugs were well tolerated by the patients and only small number of patients discontinued the drug intake due to the side effects including hypotension (0.7-1.6%), bradycardia (0-3.5%), exacerbation of heart failure (2.0-4.9%), renal impairment (0-1.2%), and respiratory compromise (0.5-1.2%).
The lead author gave a disposition that discontinuation of β blockers is the reason for preconceived side effects and he supported his argument by suggesting that it is the ‘intolerance’ of the drug that creates such a false events associated with it. He also discouraged the practice of halting the drug’s treatment in women and elderly patients suffering with HFrEF in sinus rhythm. The final verdict regarding the use of β blockers for the treatment of (HFrEF) patients was concluded as positive.
Dr Arno Hoes, who is MD at the University Medical Center, Utrecht, Netherlands, an independent expert, not affiliated with the study, gave his viewpoint regarding efficacy of the drugs, in an editorial by saying that these findings have established a scientific proof that is in conformity with the results from the clinical practice. Women and older adults with HFrEF in sinus rhythm should be taking advantage of this drug more. However, he does caution against the possible side effects and emphasized to register them down by the doctor and the patient. Side effects of β blockers, at a ‘comparable rate’, are highlighted in the trials too.
American College of Cardiology describes heart failure caused due to reduced ejection fraction (HFrEF) as a ‘growing clinical problem worldwide’ that results in increased disease and death rates. They defined chronic heart failure as a ‘hypercoaguable state’ i.e., marked with increased amounts of blood clots in the arteries and major veins of the circulatory system, caused due to the increased incidence of left ventricular (LV) thrombi, ischemic strokes, and other thromboembolic events occurring in the ‘setting’ of normal rhythm of the heart.
The beta blocker drugs, according to American Heart Association, are the drugs, which are used for lowering blood pressure by the help of reducing ‘heart rate’, ‘the heart’s workload’ and ‘the heart’s output’ of blood. Some of the commonly used drugs are: Sectral (acebutolol), Tenormin (Atenolol) and Zebeta (bisoprolol fumarate) etc.
Some of the reported side effects of beta blockers are: Insomnia, cold hands and feet, tiredness or depression, slow heartbeat and asthma.