Medication after Myocardial Infarction – Life-Long? A Cryptic Answergerman translation / full article
For how long should a patient with a myocardial infarction seven years ago should take the substances ASS, statins, ACE inhibitors, beta blocker as recommended in guidelines – if he has clinically no heart failure or hypertension?
Guidelines of the leading academic institutions in Germany, UK and the US as well as the European Society of Cardiology (ESC) recommend a life-long medication. But the British NICE and the German NVL exclude patients from a life-long medication with ACE Inhibitors and beta-blocker who have no hypertension or any other indication for these substances. Beta blockers should be given for only 1 or 2 years. This limitation is not mentioned in the guideline from the US and the ESC.
If looking at the studies cited in guidelines as the evidence base for ACE inhibitors and beta blocker after myocardial infarction one finds that most studies have only a follow-up of less or just 2 years. Studies on ASS and statins have much longer follow-ups and – different to ACE inhibitors and beta blocker – have a plausible pathophysiological explanation for a life-long medication.
Scientific evidence demands to follow the recommendation of the NICE guideline or the German NVL: No life-long medication of beta blockers and ACE inhibitors – except for different indications.