Doctors are reassessing decades of standard treatment for patients who have had heart attacks after new research shows beta-blockers may be anywhere from useless to harmful in certain cases.
The research was conducted in Spain and Italy and hit medical journals only in August, but it’s already started to impact how some Southwestern Pennsylvania cardiologists deliver care.
“It’s gone from everybody should be on it … to now it being something where, case by case, more and more of us doctors are going to choose not to put patients on it,” Dr. Amish Mehta, a cardiologist at Allegheny Health Network’s Jefferson Hospital, said Wednesday.
It may still be prudent to give most heart attack patients beta-blockers while in the hospital, Mehta noted, but he said he’s going to be more careful about prescribing them after that.
The main study found no significant difference in rates of heart attack, hospitalization for heart failure or death between patients who received beta-blockers and those who did not.
A smaller, related study looked just at women. Not only were the women seeing little benefit, researchers discovered, but beta-blockers raised their risk of death by 3%.
The studies looked at more than 8,000 patients who had what doctors call “uncomplicated” heart attacks, meaning they don’t have an irregular heartbeat or notable heart damage.
The consensus remains that patients with severe damage from complicated heart attacks should stay on beta-blockers.
For patients in the uncomplicated category, it might be time to talk to their doctor, Mehta said.
That’s a lot of patients — 80% of uncomplicated heart attack patients are on beta-blockers and, under the traditional understanding of these drugs, likely would be for life.
About 30 million adults use a beta-blocker, according to the Cleveland Clinic, though not all as a post-heart attack treatment. The drugs are also prescribed for chest pain, high blood pressure and a host of other cardiovascular conditions.
Dr. Samir Saba, co-director of the UPMC Heart and Vascular Institute, said the organization values the new research and looks forward to further studies.
Like Mehta, Saba encourages patients with questions about the latest beta-blocker research to contact their doctors for an individualized recommendation.
Patients should not stop beta-blockers cold turkey, according to the Cleveland Clinic, because it can cause effects like chest pain and heart attack.
Independence Health System did not return a request for comment.
Beta-blocker basics
Beta-blockers — a class of drugs that includes metoprolol, carvedilol and atenolol — work mostly by lowering blood pressure and relaxing the heart, making it squeeze more gently as it pumps blood throughout the body.
“When it comes to heart attacks, they make the heart work less, and the feeling was always that would be beneficial after a heart attack because of the stress the heart may have been under,” Mehta said.
When beta-blockers were first becoming popular in the 1980s, doctors had limited ways they could treat heart attacks, according to Mehta. There were no fast-acting surgeries to clear blockages, as hospitals offer today.
Care at the time basically consisted of giving patients a bed, putting them on blood thinners and hoping they pulled through, he said.
The result was more patients with serious heart damage — ones who would benefit more from beta-blockers. Clinical trials at the time indicated a major medical advancement.
‘Nothing happens quickly’
This isn’t the first time conventional wisdom has shifted on beta-blockers.
Doctors used to think it was dangerous to give certain heart failure patients the drugs because their bodies were already circulating blood so poorly that relaxing the heart further could lead to disaster. It later turned out the medications worked remarkably well on these patients.
Transforming the standard of care took time, Mehta noted.
“Anything like this takes time to just kind of have people process it,” Mehta said. “Nothing happens quickly, for better or for worse.”
Jack Troy is a TribLive reporter covering business and health care. A Pittsburgh native, he joined the Trib in January 2024 after graduating from the University of Pittsburgh. He can be reached at
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