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  • AHA/ACC 2023...

AHA/ACC 2023 Guidelines Downgrade Long-term Use of Beta Blockers

Written By : Dr. Prem Aggarwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-09-04T12:00:17+05:30  |  Updated On 16 Sept 2023 2:05 PM IST
AHA/ACC 2023 Guidelines Downgrade Long-term Use of Beta Blockers
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The American College of Cardiology (ACC), American Heart Association (AHA), and other specialty societies have released new guidelines for managing chronic coronary disease. The new guideline recommends that long-term use of beta-blocker therapy is not recommended in every patient with chronic coronary disease.

Long-term use of beta-blocker therapy is no longer recommended to improve outcomes in patients with chronic coronary disease in the absence of myocardial infarction (MI) in the past year, left ventricular ejection fraction (LVEF) < 50%, or another primary indication for beta-blocker therapy. The guidelines also suggested calcium channel or beta-blockers as first-line antianginal therapy.

The beta blockers widely in clinical use include metoprolol tartrate, metoprolol succinate, nebivolol, bisoprolol, carvedilol, labetalol, propranolol, nadolol, timolol and sotalol.

The 2023 AHA/ACC Guideline for managing patients with Chronic Coronary Disease is published online in the latest issue of Circulation. It was developed in collaboration with and endorsed by the American College of Clinical Pharmacy(ACCP), the American Society for Preventive Cardiology (ASPC), the National Lipid Association(NLA), the Preventive Cardiovascular Nurses Association (PCNA), and the Society for Cardiovascular Angiography and Interventions.

The new guideline updates and consolidates new evidence since the 2012 and 2014 guidelines for the diagnosis and management of patients with Stable Ischemic Heart Disease (SIHD)

The updated guideline emphasized the importance of team-based, patient-centre care that considers social determinants of health and associated costs while incorporating shared decision-making in risk assessment, testing, and treatment.

Recommendations on Pharmacological Management

Regarding guidelines on pharmacological treatment, another key recommendation includes using sodium-glucose cotransporter 2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) for selected patients with chronic coronary disease, including groups without diabetes.

The recommendation for statins as the first-line lipid-lower therapy in patients with chronic coronary disease remains unchanged. Several adjunctive therapies (e.g., ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, inclisiran, bempedoic acid) may be used in select populations.

The new guideline also suggested that shorter durations of dual antiplatelet therapy (DAPT) are safe and effective in many circumstances, particularly when the risk of bleeding is high and the ischemic risk is low to moderate.

Non-Pharmacological Interventions

The 2023 guideline also recommended non-pharmacological interventions for all patients with chronic coronary disease, including healthy dietary habits and exercise. Those patients who are free from contraindications are encouraged to participate in habitual physical activity, including activities to reduce sitting time and increase aerobic and resistance exercise. The updated guideline also noted cardiac rehabilitation's significant cardiovascular benefits in eligible patients, including decreased morbidity and mortality outcomes.

Other Recommendations

Routine periodic anatomic or ischemic testing without a change in clinical or functional status is not recommended for risk stratification or to guide therapeutic decision-making in patients with chronic coronary disease.

Reference: Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148:e9–e119. doi: 10.1161/CIR.0000000000001168

acc/aha guideline 20232023 acc/aha guidelineacc/aha guideline updatebeta blockeracc/aha guideline on beta-blockerbeta blocker long term usechronic coronary diseasechdacc/aha guideline on chronic coronary diseaseaha acc guideline 2023acc aha 2023aha/acc 2023aha/accaha/acc guideline 2023aha/acc guideline update
Dr. Prem Aggarwal
Dr. Prem Aggarwal

Dr Prem Aggarwal, (MD Medicine, DNB Cardiology) is a Cardiologist by profession and also the Co-founder and Chairman of Medical. He focuses on news and perspectives about cardiology, and medicine related developments at Medical Dialogues. He can be reached out at drprem@medicaldialogues.in

Dr. Kamal Kant Kohli
Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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