Beta-blockers are widely prescribed after myocardial infarction, but the question of their long-term use remains debated. The ABYSS trial recently called this practice into question, suggesting that stopping beta-blockers may not be as safe as previously thought.
- The ABYSS trial questions the need to continue beta-blockers indefinitely after myocardial infarction.
- No significant differences in mortality or cardiovascular events were observed between those who stopped and those who continued treatment.
- Individual assessment is essential, and physicians should remain attentive to the results of further future studies.
Beta-blockers are widely prescribed after myocardial infarction, but the question of their long-term use remains debated. The ABYSS trial recently called this practice into question, suggesting that stopping beta-blockers may not be as safe as previously thought.
In France, it is estimated that approximately 80,000 to 100,000 Myocardial infarction occurs every year. Are beta-blockers, long considered a mainstay of post-infarction management, still essential beyond the first year? This question, essential for many patients and cardiologists, was recently revisited by the ABYSS trial, whose results are both intriguing and potentially revolutionary.
Beta-blockers prescribed for 50 years after a heart attack
For nearly fifty years, beta-blockers have been routinely prescribed after myocardial infarction (MI), primarily to reduce mortality and prevent recurrence. However, these recommendations were based on old studies, conducted at a time when MI treatments were much less sophisticated than today. With the evolution of care, including angioplasty and rapid patient management, the role of beta-blockers in the post-MI phase deserves to be reevaluated.
The ABYSS trial, presented at ESC 2024 and published in the New England Journal of Medicine, sought to answer this question by comparing two groups of patients: those who continued their beta-blocker treatment after an MI and those who stopped it. The results were striking: no significant difference was observed in terms of mortality or major cardiovascular events between the two groups. In contrast, stopping treatment led to a slight increase in blood pressure and heart rate, without any notable improvement in the patients’ quality of life.
Discontinuation of beta-blockers after a heart attack would not be justified
These results suggest that, contrary to popular belief, discontinuation of beta-blockers after MI, even in patients without heart failure or arrhythmia, may not be justified. Indeed, patients who discontinued treatment had a slightly higher incidence of cardiovascular events, although this difference was not statistically significant.
Why then this persistent belief that beta-blockers must be continued indefinitely? Historically, their effectiveness has been demonstrated in contexts where patients were at much higher risk. Today, with modern techniques such as angioplasty and better management of risk factors, the situation has changed, but medical practices are sometimes slow to adapt.
Continue treatment if tolerance is good
However, the ABYSS trial is not without its critics. Its open-label design, where patients and doctors knew which treatment they were receiving, introduces potential bias. In addition, the beta-blockers used were not always those that had been the subject of the most rigorous studies. It is therefore possible that the results were influenced by these factors.
So what should be done in practice? For now, experts recommend continuing beta-blockers in patients who tolerate them well, pending the results of other ongoing studies. Each patient’s case should be assessed individually, taking into account their medical history and preferences. It is possible that in the near future, recommendations will evolve to allow greater flexibility in the use of these drugs.
The ABYSS trial is just the beginning of a reevaluation of current cardiology practices. As medicine evolves, it is crucial to ask the right questions and challenge dogma, especially when the scientific evidence is not as clear as it once was. Beta-blockers have saved millions of lives, but it may be time to rethink their long-term use, especially in a world where heart attack treatments have advanced dramatically.
The ABYSS trial reopens the debate on the prolonged use of beta-blockers after myocardial infarction. While the results suggest that discontinuation of treatment may not be beneficial, it is essential to consider each patient individually. Practitioners should remain vigilant and await the results of further studies before adjusting their practices.
The psychological impact of beta-blockers
Beyond the physical effects, beta-blockers also have an impact on the psyche of patients. By reducing heart rate, they can alleviate symptoms of anxiety, which are often present after a heart attack. However, some patients report side effects such as fatigue, nightmares, or a feeling of emotional detachment. The role of beta-blockers in the management of post-infarction stress therefore deserves to be explored further, in particular to determine whether other approaches could offer the same benefits without these side effects. Appropriate psychological support could prove essential, especially if we are considering reducing dependence on these drugs.
