Some heart medications may not be the best fit for every form of heart failure

Beta blockers may need a more careful look in some people with heart failure whose hearts still pump relatively well, according to a study. Researchers found an association between these drugs and higher rates of hospitalization for heart failure in one subgroup, but the analysis did not prove the medications caused those admissions.

That matters because heart failure is not one single condition. Different forms of the disease may respond differently to the same treatment, and recognizing those differences can help doctors choose therapy based on why a patient’s heart is struggling.

The broader promise is more personalized prescribing. Looking at why a medication was started, what other conditions it is treating, and how the patient is responding can lead to better decisions without assuming that a commonly used drug is wrong for everyone.

The study, published in JAMA Network Open, was led by researchers at the University of Vermont Larner College of Medicine. It analyzed data from 1,761 participants in North and South America who were enrolled in the TOPCAT heart failure trial.

The researchers examined heart failure with preserved or near-preserved ejection fraction. Ejection fraction is the share of blood pumped out of the heart’s main pumping chamber with each beat, and a normal reading does not mean the heart is completely healthy.

With this type of heart failure, stiffness and poor filling can lead to shortness of breath, fluid retention and trouble with physical activity. That is different from heart failure in which the heart’s pumping strength is clearly reduced.

Matching treatment to the patient is also the goal of research into a test that may help predict who benefits most from a heart failure medicine.

About four out of five participants were taking a beta blocker. Among those with an ejection fraction of at least 50%, beta blocker use was associated with a 74% higher relative risk of hospitalization for heart failure after statistical adjustment.

The team did not see a significant rise in cardiovascular deaths. It also did not find the same clear link to hospitalization among participants with ejection fractions between 45% and 49%, showing why the results should not be applied to every patient in the same way.

A major limitation is that TOPCAT did not randomly assign people to beta blockers. The trial was testing another drug, spironolactone, so people who took beta blockers may have differed in important ways from those who did not, even after adjustment.

Beta blockers also have well-established uses in other conditions, including heart failure with reduced pumping function and certain heart rhythm disorders. A patient may therefore have a valid reason to take one even if this analysis raises questions about another part of their treatment.

Patients should speak with their prescribing clinician before making any changes, rather than stopping treatment suddenly. The study supports careful review and more research, not the idea that beta blockers inevitably worsen heart failure or that all patients should switch medications.

If you are interested in this topic, please read articles about Foods linked to inflammation could harm people with heart failure, and The Mediterranean diet could protect heart health in people with heart disease.

For more information, please see articles about Omega-3 fatty acids and heart health: What you need to know, and Exploring the best diet for people with heart rhythm disorders.

Source: University of Vermont Larner College of Medicine.