Journal Wrap | CHARISMA Analysis: Beta-blockers Linked with Improved Outcomes in Some Patients

Patients on beta-blockers with prior myocardial infarction (MI) but without heart failure (HF) had a lower risk of recurrent MI and lower composite cardiovascular outcomes, results from a study indicated.

While beta-blockers are "widely regarded as one of the most important therapies in clinical medicine of the 20th century," according to the study authors, their role in the long-term reduction of cardiovascular (CV) outcomes remains controversial. With this in mind, the researchers for the CHARISMA trial included a total of 15,603 patients: 4,772 patients with prior MI, 7,804 patients with known atherothrombosis, and 2,101 patients without HF but also with risk factors in the study. Patients with a history of HF were excluded from the study (n = 926). Patients were then divided into two groups based on baseline beta-blocker use.

The primary endpoint was a composite of nonfatal MI, stroke from any cause, or CV death. The authors used Cox proportional hazard models to determine the effects of prior beta-blocker use and the primary study endpoint, and used propensity score matching for each cohort.

The use of beta-blockers was associated with a 31% lower risk of the primary outcome in the propensity score-matched prior MI cohort (70 [7.1%] vs. 100 [10.2%]; HR = 0.69, 95% CI, 0.50-0.94; p = 0.021). This risk reduction was driven primarily by a reduction in recurrent MI risk (33 [3.4%] vs. 48 [4.9%]; HR = 0.62, 95% CI, 0.39-1.00; p = 0.049), although there was no reduction in mortality. There was a trend for an increase in stroke risk in the risk factors alone cohort, which was shown to be significant in the regression model once adjusted to the propensity score (p = 0.006), as well as in multivariable models. The researchers reported no differences in mortality, CV mortality, stroke, or hospitalization in the atherothrombotic disease and risk factor alone cohorts.

Bangalore S, Bhatt D, Steg G. Circ Cardiovasc Qual Outcomes. 2014;doi:10.1161/CIRCOUTCOMES.114.0010.73

Keywords: Myocardial Infarction, Stroke, Propensity Score, Adrenergic beta-Antagonists, Risk Reduction Behavior, Heart Failure, Hospitalization

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