A pre-specified quality of life sub-study from the REDUCE-AMI trial found that patients who experienced myocardial infarctions with preserved left ventricular ejection fraction and received beta-blockers showed higher depression scores compared with those who did not receive the medication.
In the study, published in European Heart Journal: Acute Cardiovascular Care, investigators analyzed 806 patients between August 2018 and June 2022. They conducted a parallel-group, open-label, registry-based randomized trial using the Hospital Anxiety and Depression Scale (HADS). The investigators collected measurements at hospitalization and two follow-up points. Inclusion criteria comprised patients recruited within 1 to 7 days after myocardial infarction (MI), who underwent coronary angiography, showed confirmed obstructive coronary artery disease, and maintained preserved left ventricular ejection fraction (LVEF) (≥ 50%).
At baseline, 27% of the patients registered as possible cases of anxiety (mean = 5.6, standard deviation [SD] = 3.9) and 14% as possible cases of depression (mean = 3.9, SD = 3.2). The study population had a mean age of 64.7 years (SD = 10.4), and 77% were male.
The population included patients with various documented conditions: 50% had hypertension, 16% had diabetes, 7% had previous percutaneous coronary intervention, and 8% had previous MI. At follow-up one, 42% were on beta-blocker medication, decreasing to 39% at follow-up two.
The research showed that beta-blocker treatment correlated with increased depressive symptoms at both 6 to 10 weeks (β = 0.48, 95% confidence interval [CI] = 0.09–0.86, P = .015) and 12 to 14 months (β = 0.41, 95% CI = 0.01–0.81, P = .047) post-MI.
In patients without prior beta-blocker treatment (n = 694), those receiving beta-blockers showed higher depression scores at follow-up one (β = 0.41, 95% CI = 0.00–0.82, P = .050). Among the patients with previous beta-blocker treatment (n = 111), the beta-blocker group showed higher depression scores at follow-up two (β = 1.17, 95% CI = 0.03–2.31, P = .044).
The researchers documented several study parameters: the open-label design, measurements collected after treatment assignment, and a sample of patients who experienced MI with preserved LVEF and no contraindications for beta-blockers. The study population showed lower depression rates (14%) compared with previously documented MI patient populations (20% to 40%).
The study recorded an absolute difference in depressive symptoms between groups of approximately 0.5 points on the HADS scale. The REDUCE-AMI trial showed no statistically significant difference for beta-blocker initiation on all-cause mortality and recurrent MI in this patient population.
Conflict of interest disclosures can be found in the study.
