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Patients Experiencing Myocardial Infarctions Not Receiving Enough Beta Blockers

For nearly 40 years drugs known as beta blockers have been proven to increase patients’ survival prospects following a heart attack. In a breakthrough study released in the American Heart Journal, Northwestern Medicine cardiologist Jeffrey J. Goldberger, MD, found the majority of patients are frequently not receiving a large enough dose of these drugs, which can put their recovery from heart attacks and overall health into peril.

“Only 46 percent of patients studied were taking 50 percent or more of the target dose of beta blockers shown to be beneficial in clinical trials,” said Goldberger, director of cardiac electrophysiology research for the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital. “Furthermore, 76 percent of patients were still being treated with the same amount of medication given at discharge. This means that for the vast majority of patients, there wasn’t even an attempt to increase their dose.”

Northwestern Memorial was one of 19 sites that participated in the PACEmaker and Beta-blocker Therapy Post-Myocardial Infarction (PACEMI) Trial Registry. Nearly 2,000 patients, who had been treated for a heart attack, were enrolled.

Study participants were prescribed very low doses at discharge, in part to assess how their bodies were likely to react to the drug. Researchers then followed up three weeks later to determine if patients’ personal physicians had adjusted the dosage.

“One of the reasons for the low dosage at discharge from the hospital can be attributed to patients’ shorter length of hospital stay,” said Goldberger. “Patients can be in and out of the hospital within two days after a heart attack, and this short amount of time doesn’t allow for us to increase their medication to the target dose while they are still here.”

Goldberger added that there is not yet a system in place for what should happen as an outpatient that used to happen as an inpatient.”Patients might see one doctor in the hospital but a different one in the office, and those two might not be conferring on the appropriate amount of beta blockers.” These findings make it clear that patients and their personal physicians need to work together and have better communication.