A new study led by Timothy Plante ’06, M.D.’11, M.H.S., published in JAMA Network Open highlights the need for more personalized care in heart failure, Knowridge reports. It’s a reminder that good intentions—even with trusted medications—can have unintended consequences if we don’t take the time to understand each patient’s unique condition.
Heart failure is a serious health problem in the United States, affecting millions of people and placing a heavy burden on the health care system. In many cases, heart failure is caused by a weak heart muscle that struggles to pump blood. But about half of patients have a different type—one where the heart’s pumping strength is normal, but it becomes stiff and can’t relax properly. This type is known as “stiff heart” heart failure, or more formally, heart failure with preserved ejection fraction (HFpEF). It’s common in older adults, especially women, and is often harder to treat.
A new study from the University of Vermont (UVM) is raising questions about a popular group of medications called beta-blockers, which are widely used in heart patients.
Beta-blockers help by slowing the heart rate and lowering blood pressure, reducing the workload on the heart. They are a standard, life-saving treatment for patients with “weak heart” failure—where the heart’s pumping ability is reduced. But for people with “stiff heart” failure, the benefits of beta-blockers are unclear. Since the heart’s pumping function is preserved in these patients, the problem lies in the heart’s ability to relax and fill with blood.
The UVM researchers, led by Plante, an associate professor of medicine at the Larner College of Medicine, wanted to find out whether beta-blockers help or harm these patients. They found that people using beta-blockers had a 74 percent higher risk of being hospitalized for heart failure compared to those not taking them. The study suggests that, in “stiff heart” heart failure, beta-blockers might actually make things worse: Because the heart is already having trouble relaxing, slowing it down with beta-blockers may cause pressure to build up in the heart and lungs. This can lead to more fluid retention and make breathing more difficult—exactly the kind of symptoms these patients are trying to avoid.
What makes this finding especially concerning is that beta-blockers are commonly prescribed to patients with all types of heart failure. Yet they have not been well studied in “stiff heart” cases. This means doctors may be giving patients a medication that doesn’t help—and could even cause harm—simply because it works well for a different kind of heart problem.
The takeaway from this research is that heart failure is not a one-size-fits-all condition. Just because two people have similar symptoms doesn’t mean they should get the same treatment. For patients with “stiff heart” failure, it’s important to have open conversations with their doctors about whether beta-blockers are truly the right choice.