Beta blocker improves heart patients' quality and length of life, study shows

March 7, 2000
Web posted at: 4:40 p.m. EST (2140 GMT)

From staff and wire reports

NEW YORK (CNN) -- A medicine known to extend the lives of some heart-disease patients has now been shown to reduce hospital visits, lessen uncomfortable symptoms and generally improve patients' lives, researchers reported Tuesday.

The results came from a study of 3,991 patients in the United States and 13 European countries. The research tested metoprolol, a beta blocker drug. Beta blockers reduce the heart's workload by blocking its response to stress hormones.

Last June, medical investigators reported that metoprolol reduced deaths by 34 percent among heart patients in the study. Their analysis of additional benefits appears in this week's Journal of the American Medical Association.

The additional assessment supports earlier research and should diminish long-standing concerns among some heart doctors that beta blockers could worsen heart disease, said experts not involved in the study.

Heart association updating guidelines

Because of this and other recent studies, the American Heart Association is updating its heart-failure treatment guidelines. It had previously urged "considerable caution" in the use of beta blockers, but will now recommend them for most heart-failure patients, said Dr. Sharon Hunt, a Stanford University cardiologist and chair of the updating committee.

The drug tested was a long-acting beta blocker with controlled-release and extended-release properties, known as metoprolol CR/XL.

In a JAMA editorial, two cardiologists from Duke University wrote, "In summary, this trial demonstrates that using metoprolol CR/XL achieved three of the four potential goals of therapeutic intervention: it caused patients to live longer and feel better and it allowed them to avoid unpleasant experiences -- hospitalizations and sudden arrhythmias."

The fourth goal is cost effectiveness, and while not formally studied, the treatment appears to be "cost-neutral or cost- saving" compared to other therapies, said Dr. Robert M. Califf and Dr. Christopher M. O'Connor of Duke.

Metoprolol, sold in the United States under the brand name Toprol XL, is made by AstraZeneca, which funded the study. It is awaiting approval by the U.S. Food and Drug Administration for use in heart failure. Only one beta blocker has such approval: carvedilol, which is marketed as Coreg and made by SmithKline Beecham.

Millions suffer from heart failure

Heart failure involves a damaged or overworked heart that cannot pump efficiently. It afflicts an estimated 4.8 million Americans and is a leading cause of hospitalization. Heart failure caused 45,419 deaths in 1997, the latest available figures, according to the heart association. The symptoms often include breathlessness and swelling in the legs.

Conventional treatment includes diuretics to reduce fluids and drugs called ACE inhibitors to dilate blood vessels. Beta blockers have been used since the 1960s to treat high blood pressure and some heart conditions. More recently they have been recommended for heart-attack survivors, but because they slow the heart rate, concern arose that they could make heart failure worse.

The international study was led by Dr. Ake Hjalmarson of Sahlgrenska University Hospital in Gothenburg, Sweden. He and his colleagues followed the heart-failure patients for about one year. All were taking conventional medication. In addition, about half were given metoprolol; the rest were given a placebo.

As previously reported, there were significantly fewer deaths in the metoprolol group. But there also were about a third fewer hospitalizations, and symptoms improved in 28.6 percent of the beta-blocker group, compared with 25.8 percent of the placebo group.

More beta-blocker patients also reported feeling better, 50 percent verses 40 percent.

Editorial says data 'overwhelming'

The editorial in JAMA said surveys in the United States and other countries indicate that less than 30 percent of eligible patients are being treated. "The time has come to initiate beta-blocker treatment in the large number of patients with heart failure in need of this therapy, which should both improve their quality of life and increase its length."

Califf and O'Connor in the editorial urged speedier and less expensive trials for new heart therapies. They noted that benefits from beta blockers long have been known but that many cardiologists were reluctant to use the medicines.

"Physicians can no longer accept the argument that absence of adequate knowledge is a reason for underuse of (beta) blockers," wrote Califf and O'Connor.

"The data are overwhelming, and they have been published in leading medical journals that should be read by most practitioners. Instead, it is necessary to accept that patients are now suffering the consequences of inadequate practice in the face of adequate knowledge."

They concluded, "Patients deserve better than a 17-year delay before physicians are proven wrong in their routine teaching about clinical practice."

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