6 NEWS
6 NEWS
19 SEPTEMBER 2025 ausdoc. com. au
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TRIPLE
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Beta blocker role doubted post-MI
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TRIMBOW1
* Trimbow is the only triple therapy PBS listed for severe asthma in two strengths and COPD( 100 / 6 / 10) 2
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ASTHMA 2
Studies show no benefits for patients with higher LVEF.
Jamie Thannoo CARDIOLOGISTS are re-evaluating their prescribing of beta blockers for patients with uncomplicated MI and left ventricular ejection fraction above 40 %, as several studies question the benefits.
A randomised, open-label trial, published in The New England Journal of Medicine last month, concluded that beta blockers had no effect on mortality, secondary MI or hospitalisation for heart failure in these patients.
The study, called REBOOT, involved 8500 European participants( 81 % male; mean age 61), with left ventricular ejection fraction( LVEF) > 40 %. There was a median follow-up of 3.7 years.
Lead author Dr Borja Ibáñez called it“ one of the most significant advances in heart attack treatment in decades” given that, globally, 80 % of patients with uncomplicated MI were discharged on beta blockers.
Tasmanian cardiologist Dr Andrew Black, who was not involved in the study, said he had already seen specialists adapt their practices amid a slew of studies reassessing the role of beta blockers.
He told Australian Doctor he tweaked his practice after a 2024 study, also published by The New England Journal of Medicine, found no effect on all-cause mortality with beta blockers for patients with LVEF > 50 %.
“ Most of the data showing benefit for beta blockers after MI was from before the age of routine reperfusion,” said Dr Black, from the Royal Hobart Hospital.
“ We’ ve all wondered for the last 5-10 years how much benefit patients derive from beta blockers if they still have normal systolic function.”
However, a meta-analysis published in The Lancet last month, which included REBOOT’ s findings, concluded that beta blocker therapy remained beneficial for patients with 41-49 % LVEF.
It found treatment was associated with a 25 % reduction in a composite outcome of death, secondary MI or hospitalisation.
The REBOOT authors said their study involved fewer than 1000 patients with LVEF < 50 %, meaning their data were hard
Cardiologists have adapted their practices. to interpret for this group, but that ultimately both findings pointed to a lack of benefit in people with preserved ejection fraction.
Dr Black stressed that patients with preserved LVEF could require beta blockers for other indications.
“ There are people with AF, people with hypertension, incomplete revascularisation,” he said.
“ However, the reflex to just put everyone on a beta blocker after a heart attack is probably going to stop.”
The Heart Foundation guidelines on secondary prevention after acute coronary syndrome acknowledge a lack of evidence on beta blocker therapy for patients
with preserved ejection fraction. New Engl J Med 2025; 30 Aug. Lancet 2025; 30 Aug.
Dr Andrew Black.
Trimbow 100 / 6 / 10 & 200 / 6 / 10 are indicated for maintenance treatment; in adults with asthma not adequately controlled with a maintenance combination of medium dose or high dose ICS / LABA respectively, and who experienced ≥1 exacerbation( s) in the previous year. Trimbow 100 / 6 / 10 is indicated in adults with moderate to severe COPD who are not adequately treated by ICS / LABA or LABA / LAMA. 1
PBS Information: Authority required( STREAMLINED). Severe Asthma. Chronic Obstructive Pulmonary Disease( 100 / 6 / 10 mcg presentation only). Criteria Apply. Refer to PBS for full information.
Please review Product Information before prescribing. Product Information is available by scanning the QR code.
Abbreviations: COPD: chronic obstructive pulmonary disease; ICS: inhaled corticosteroid; LABA: long-acting beta 2 agonist; LAMA: long-acting muscarinic antagonist; PBS: Pharmaceutical Benefits Scheme; pMDI: pressurised metered dose inhaler. References: 1. Trimbow Approved Product Information. 2. Pharmaceutical Benefits Scheme( PBS). www. pbs. gov. au. Chiesi Australia Pty Ltd, Hawthorn East, VIC. 3123, Australia. Tel: + 61 3 9077 4486; Fax: + 61 3 8672 0792; Email: medinfo. au @ chiesi. com. Copyright © Chiesi 2025. All rights reserved. Date of preparation: January 2025. AU-TRI-2500008. CHIE00211C.
Nurse accidentally defibs awake patient
Carmel Sparke A NURSE who was sacked after accidentally defibrillating a conscious patient has failed in her unfair dismissal claim.
She was working in a Melbourne ED when she“ unintentionally” delivered an unsynchronised 200-joule defibrillation shock to the patient, the Fair Work Commission heard.
The nurse said the event at Sunshine Hospital unfolded shortly after she had introduced herself to the patient, who had an arterial line with a dressing.
There was“ no clue” that he was attached to the defibrillator, she said.
“ I informed the patient that I would be changing the dressing shortly. I then began to check the equipment,” the nurse told Western Health after the July 2024 incident.
“ The defibrillator was turned off and placed in the corner where it usually is when not in use.
“ I turned on the defibrillator and checked it.
“ An accidental and unintentional shock was delivered to the patient.” The nurse said the patient had“ joked” with her after she apologised for the shock, while the commission heard the patient retained normal
‘ I turned on the defibrillator and checked it.’
vital signs afterwards and was able to speak.
An emergency registrar in the same room recalled hearing the sound of a defibrillator charging, then seeing the patient“ jump” in his bed and“ loudly” cry out.
Before the incident, the patient was sitting up, with his eyes open and connected to all the usual monitoring equipment— the ECG, defibrillator, blood pressure monitor and pulse oximeter, the registrar said.
Delivering a shock to an awake patient could have caused a cardiac arrest with other risks including pain, distress and long-term psychological consequences, the commission heard. After admitting she had made a mistake, the nurse went home upset.
She was placed on leave with full pay while the incident was investigated, and she was eventually told she would be redeployed to an area outside emergency care.
However, she rejected the offer.
She was dismissed about three months after the defibrillation incident, with the health service telling her it“ no longer has trust and confidence in [ her ] ability”.
However, the nurse told the commission she believed her sacking was unfair, because it followed months of being bullied and harassed since she started her postgraduate training in critical care nursing with the hospital.
The commission heard she had struggled to progress through the course and required multiple attempts to pass key competencies.
These included two attempts to pass Advanced Life Support, two attempts at Non-Invasive Ventilation, three attempts to pass Mechanical Ventilation, and three attempts at Rapid Sequence Intubation.
The nurse believed she had been unfairly assessed and was being treated unjustly because she was allocated fewer shifts in the resuscitation area than her colleagues.
She also blamed the stress around this issue for the defibrillation incident.
Ultimately, the commission dismissed her application, finding her dismissal was not harsh, unjust or unreasonable.
HIE00211C ADG TrImbow third vertical 80x375mm _ FA. indd 1 28 / 1 / 2025 10:28 am