After a heart attack, beta-blockers are often a lifelong medicine. Maybe they shouldn’t be - cnn.com

Beta-blockers are a class of prescription medications that can help lower blood pressure and slow heart rate, and they are commonly used to treat a wide range of cardiovascular concerns. Although they are generally considered safe, they may carry some side effects including fatigue, dizziness, dry mouth or eyes, or in rare cases sexual dysfunction.

For more than 40 years, beta-blockers have been commonly prescribed as a standard treatment for adults who have had heart attacks with no complications, to reduce the risk of another cardiovascular event, and many people continue the medications for life. But a growing body of research has begun to question that approach.

Although each patient’s case is different, some doctors now argue that using beta-blockers for a year or two if needed rather than a lifetime could help people avoid unnecessary side effects and save money.

‘The evidence is changing’

The American Heart Association and the American College of Cardiology regularly issue joint guidelines on treating heart conditions. In 2023, a guideline for treating patients with chronic coronary disease was updated to not recommend long-term beta-blocker therapy in these patients if they had not had a heart attack in the past year.

More recent guidelines acknowledge that there is evolving data around the long-term use of beta-blockers after a heart attack, said Dr. Manesh Patel, president-elect of the American Heart Association and cardiologist and professor at the Duke University School of Medicine.

“Beta-blockers were originally used in patients who were having heart attacks before we had a lot of the more recent technological advances – such as opening the artery fast with angioplasty, saving the heart muscle, even some of the blood thinners and cholesterol medications we use. Those advances were just coming about when beta-blockers were first studied to show a benefit in patients who had a heart attack,” Patel said.

Emerging research “may allow us, in real time, to start to de-escalate some of the therapies we have,” he said. “The evidence is changing, and it does look like for patients that are stable after having a heart attack, there’s more data on the risks and the benefits that look like you could potentially stop chronic beta-blocker therapy.”

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The shifting standard of care could have a “significant” impact on how much money heart attack survivors may spend on beta-blockers throughout their lives, said Dr. Joseph Ravenell, an associate professor of population health and medicine at NYU Langone Health in New York.

“If we’re able to achieve essentially the same mortality benefit but avoid patients having to be on medications for a lifetime, I can’t see that as being anything but positive – both from a quality of life standpoint as well as from a health economic standpoint,” Ravenell said.

Many beta-blockers are generally affordable, costing around $20 or less for a month supply, but that can add up over a lifetime.

“If you think about how much you spend per month on that, multiply that times a lifetime, then that’s one example of the potential cost savings,” he said. “And when we think about why patients often don’t comply with medication regimens, it’s usually because of side effects or because of costs, and so anything we can do to reduce the burden of pharmacotherapy on patients with chronic conditions, it’s a win.”

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Some doctors around the world are already changing their approach to prescribing beta-blockers for heart attack survivors in the long term, said Dr. Valentin Fuster, president of Mount Sinai Fuster Heart Hospital and general director of Spain’s Centro Nacional de Investigaciones Cardiovasculares.

“In the last 10 to 15 years, some people – including myself – have questioned the role of beta-blockers in patients who had good heart or good ventricular function,” Fuster said.

On a broader scale, “I think a change in practice is going to happen. It’s already happening with the papers that we published recently,” he said. “I think people will be much more cautious in giving beta-blockers to patients who have good ventricular function.”