Dr. Amit Vora discusses the use of beta-blockers in certain patient populations. While beta-blockers are clearly beneficial for up to 3 years in post-MI patients and for those with LV ejection fraction below 0.40, their use in other groups is less certain. Specifically, a study found beta-blockers given at discharge to stable angina patients without prior MI or HF undergoing elective PCI did not decrease mortality, revascularization or rehospitalization. Additionally, beta-blockers have potential adverse effects and may fail to provide benefits given current standard therapies. Their use should be limited to post-MI patients and those with CHF and reduced LVEF.

1. Dr. Amit Vora
Mumbai
Obviously in selected Patients

2. ✓
✓
✓

8. JAMA. 2012;308(13):1340-1349

9. JAMA. 2012;308(13):1340-1349

10. JAMA. 2012;308(13):1340-1349

11. JAMA. 2012;308(13):1340-1349

12. Huang, Fox KA. Scottish Medical Journal 2012;57:69-75

13. The Ochsner Journal 13:166–168, 2013

15. Prior MI
CAD, no MICAD RF only
Circ Cardiovasc Qual
Outcomes 2014;7:1-11

16. “Beta-blocker use at discharge in patients with stable angina without
prior history of MI or systolic HF undergoing elective PCI was not
associated with any decrease in mortality, revascularization and re-
hospitalization related to MI or stroke at 30-days and 3-years follow-
up,” Parikh concluded. “Over time, prescriptions of beta-blockers at
discharge have continued to increase in this population despite of
lack of clearly demonstrated objective benefits.”

18. Adverse effects of beta-blockers

19. 1. All post MI pts, up to 3 years
2. All patients with LVEF < 0.40

20. 1. Fails to reduce central aortic pressure
2. Increase in unfavorable metabolic
consequence – DM, dyslipidemia
3. Unable to provide benefit in the era of
thrombolysis & revascularization / anti-
platelets / ACE-I / Statins
4. Not well tolerated and poor adherence to Rx
NB: 4th line of Rx in hypertension

21. 1. Post MI group (up to 3 years)
2. CHF with LV systolic dysfunction
?? may consider for angina relief