A recent study has shown that discontinuing beta-blockers, once thought to be crucial after a heart attack, does not increase the risk of recurrence or death. Beta-blockers have long been the standard treatment for heart attack patients.
On Tuesday, Samsung Medical Center announced that a research team led by Dr. Han Joo Yong from the Department of Cardiology published the results of their SMART-DECISION study in the New England Journal of Medicine (NEJM).
The study evaluated the safety of discontinuing beta-blockers in stable post-heart-attack patients. It included 2,540 participants who had been taking beta-blockers for at least a year after a heart attack, had no heart failure, and maintained a left ventricular ejection fraction above 40%. Participants were randomly assigned to either stop or continue the medication, with a median follow-up of 3.1 years.
During the follow-up, the primary outcomes—death from any cause, heart attack recurrence, or heart failure hospitalization—occurred in 58 out of 1,246 patients who stopped the medication, compared to 74 out of 1,294 who continued. This statistically confirmed that stopping the medication was not inferior to continuing it.
The researchers concluded that it may be clinically safe to discontinue long-term beta-blocker treatment in stable patients with preserved heart function, noting no significant differences between the groups in other secondary endpoints.
Dr. Choi Gi Hong from Samsung Medical Center’s Cardiology Department commented that advances in heart attack treatment have led to better preservation of heart function in many patients, adding that the study offers important clinical evidence on the need for long-term beta-blocker use in this group.
Lead investigator Dr. Han Joo Yong acknowledged the study’s limitation of including only Korean patients but suggested it could prompt a reevaluation of long-term use of medications with unclear benefits in heart attack patients.
This research was selected in 2021 as a national support project by the Ministry of Health and Welfare’s Patient-Centered Medical Technology Optimization Research Group. It was conducted as a researcher-led clinical trial in collaboration with the Heart Attack Research Society over a five-year period. The study also incorporated patient-reported quality-of-life measures to validate medical technologies that benefit patients.