Beta Blockers May Not Be Best Heart Drugs for Dementia Patients
MONDAY, Dec. 12, 2016 -- Beta blocker drugs are often the go-to medication for people who've survived a heart attack.
But a new study suggests that they may not be the medicine of choice for nursing home residents with dementia.
Taking the drugs reduced the risk of death during the study period by about a quarter, the researchers said. But the drugs were also associated with 34 percent higher risk that a patient with moderate or severe dementia would be unable to independently perform the functions of daily life.
One heart expert who reviewed the findings said the study supports the notion that there's no "one-size-fits-all" approach to cardiovascular care.
The findings highlight "the importance of personalizing medical care for an individual elderly patient following a heart attack," said Dr. Kevin Marzo. He is chief of cardiology at Winthrop-University Hospital in Mineola, N.Y.
"Routine use of beta blockers following [heart attack] may cause harm in high-risk populations -- such as the elderly with dementia and fragility -- and their use should be assessed on an individual level," Marzo said.
Beta blockers are widely used and include medications such as acebutolol, atenolol, bisoprolol, metoprolol, nadolol, nebivolol and propranolol. They're used to treat high blood pressure, heart failure, abnormal heart rhythms and chest pain.
According to the study authors, prior research has shown the use of the drugs after a heart attack cuts the risk of an early death by 25 percent to 30 percent.
This new study included nearly 11,000 nursing home residents aged 65 and older who had survived a heart attack, after which half of the patients were prescribed beta blockers.
The study couldn't prove cause-and-effect, only associations. Beta blockers reduced the number of deaths within 90 days by about a quarter, the researchers reported. But use of the drugs was also associated with about one-third higher odds of reduced "ability to perform daily functions independently" in patients with moderate or severe dementia.
No such effect was seen in patients with normal mental function or mild dementia, said the research team led by Dr. Michael Steinman. He's professor of geriatrics at the University of California, San Francisco, and the affiliated San Francisco VA Health Care System.
Use of beta blockers also did not impair daily function in patients who were not already highly dependent on others to help them with basic daily activities, the study found.
"There is a lot of interest in the potential harms of drugs in older adults and how they affect one's quality of life by contributing to problems such as fatigue, dizziness and a general sense of being off," Steinman said in a university news release.
The new findings highlight "how the potential mortality benefits of drugs can be balanced by harms to quality of life in older adults, and how to manage that risk-benefit trade-off," he said.
Dr. Gisele Wolf-Klein directs geriatric education at Northwell Health in Great Neck, N.Y. She agreed that decisions regarding medications must include quality-of-life considerations.
"Since older adults are most concerned about preserving their independence in their later years of life, physicians need to individualize their approach ... particularly in frail and highly vulnerable older adults," she said.
The study was published Dec. 12 in the journal JAMA Internal Medicine.
The American Heart Association has more on beta blockers.
Posted: December 2016
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