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Randomized Controlled Trial
. 2025 Jan 11;10(8):708-718.
doi: 10.1093/ehjcvp/pvae062.

Effects of beta-blockers on quality of life and well-being in patients with myocardial infarction and preserved left ventricular function-a prespecified substudy from REDUCE-AMI

Katarina Mars  1 , Sophia Humphries  2 , Philip Leissner  2 , Martin Jonsson  1 , Patric Karlström  3 , Jörg Lauermann  3 , Joakim Alfredsson  4 , Thomas Kellerth  5 , Annica Ravn-Fischer  6   7 , David Erlinge  8 , Bertil Lindahl  9   10 , Troels Yndigegn  8 , Tomas Jernberg  11 , Claes Held  9   10 , Erik M G Olsson  2 , Robin Hofmann  1
Affiliations
Randomized Controlled Trial

Effects of beta-blockers on quality of life and well-being in patients with myocardial infarction and preserved left ventricular function-a prespecified substudy from REDUCE-AMI

Katarina Mars et al. Eur Heart J Cardiovasc Pharmacother. .

Abstract

Aims: In the Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction (REDUCE-AMI) study, long-term beta-blocker use in patients after acute myocardial infarction (AMI) with preserved left ventricular ejection fraction demonstrated no effect on death or cardiovascular outcomes. The aim of this prespecified substudy was to investigate effects of beta-blockers on self-reported quality of life and well-being.

Methods and results: From this parallel-group, open-label, registry-based randomized clinical trial, EQ-5D, and World Health Organization well-being index-5 (WHO-5) questionnaires were obtained at 6-10 weeks and 11-13 months after AMI in 4080 and 806 patients, respectively. We report results from intention-to-treat and on-treatment analyses for the overall population and relevant subgroups using Wilcoxon rank sum test and adjusted ordinal regression analyses. Of the 4080 individuals reporting EQ-5D (median age 64 years, 22% female), 2023 were randomized to beta-blockers. The main outcome, median EQ-5D index score, was 0.94 [interquartile range (IQR) 0.88, 0.97] in the beta-blocker group, and 0.94 (IQR 0.88, 0.97) in the no-beta-blocker group 6-10 weeks after AMI, OR 1.00 [95% CI 0.89-1.13; P > 0.9]. After 11-13 months, results remained unchanged. Findings were robust in on-treatment analyses and across relevant subgroups. Secondary outcomes, EQ-VAS and WHO-5 index score, confirmed these results.

Conclusion: Among patients after AMI with preserved left ventricular ejection fraction, self-reported quality of life and well-being was not significantly different in individuals randomized to routine long-term beta-blocker therapy as compared to individuals with no beta-blocker use. These results appear consistent regardless of adherence to randomized treatment and across subgroups which emphasizes the need for a careful individual risk-benefit evaluation prior to initiation of beta-blocker treatment.

Keywords: AMI: Acute myocardial infarction; EQ-5D: EuroQoL 5-dimension; EQ-VAS: EuroQoL visual analogue scale; LVEF: Left ventricular ejection fraction; QoL: Quality of life; SWEDEHEART: Swedish Web System for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies; WHO-5: World Health Organization-5.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow chart for patients within set age limit who were invited to follow-up 1 and 2 (6–10 weeks and 11–13 moths) and reported EQ-5D.
Figure 2
Figure 2
Main outcome. EQ-5D index score analysed according to intention-to-treat at 6–10 weeks and 11–13 months after acute myocardial infarction. Difference in medians calculated with Wilcoxon rank sum test with corresponding P-value. Odds ratio (OR) analysed with ordinal regression method adjusting for age and sex. IQR denotes interquartile range, OR with confidence intervals in brackets.
Figure 3
Figure 3
Secondary outcomes. EQ VAS score and WHO-5 index score analysed according to intention-to-treat at 6–10 weeks and 11–13 months after acute myocardial infarction. Difference in medians calculated with Wilcoxon rank sum test with corresponding P-value. Odds ratio (OR) analysed with ordinal regression method adjusting for age and sex. IQR denotes interquartile range, OR odds ratio with confidence intervals in brackets.
Figure 4
Figure 4
Subgroup analysis presented as a Forest Plot. EQ-5D index score stratified into subgroups according to intention-to-treat analysis at 11–13 months after acute myocardial infarction.
See this image and copyright information in PMC

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