Format

Send to:

Choose Destination
See comment in PubMed Commons below
Ann Intern Med. 1999 Nov 2;131(9):648-54.

Early beta-blocker therapy for acute myocardial infarction in elderly patients.

Author information

  • 1Yale University School of Medicine and the Yale-New Haven Hospital, Center for Outcomes Research and Evaluation, Connecticut 06520-8025, USA. harlan.krumholz@yale.edu

Abstract

BACKGROUND:

Despite the evidence supporting the importance of early beta-blocker therapy, this intervention has received little attention as an indicator of quality of care.

OBJECTIVES:

To determine how often beta-blockers are administered as early treatment of acute myocardial infarction in patients 65 years of age or older, to identify predictors of the decision to use beta-blockers, and to evaluate the association between the early use of beta-blockers and in-hospital mortality.

DESIGN:

Observational study.

SETTING:

Nongovernment, acute care hospitals in the United States.

PATIENTS:

Medicare beneficiaries who were 65 years of age or older, were hospitalized with an acute myocardial infarction in 1994 and 1995, and did not have a contraindication to beta-blocker therapy.

MEASUREMENTS:

Medical chart review to obtain information about the use of beta-blockers, contraindications to these drugs, patient demographics, and clinical factors.

RESULTS:

Of the 58 165 patients (from a total of 4414 hospitals), 28 256 (49%) received early beta-blocker therapy. Patients with the highest risk for in-hospital death were the least likely to receive therapy. Patients who received beta-blockers had a lower in-hospital mortality rate than patients who did not receive beta-blockers (odds ratio, 0.81 [95% CI, 0.75 to 0.87]), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the two groups.

CONCLUSIONS:

Early beta-blocker therapy was not used for 51% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a contraindication to this therapy. Increasing the early use of beta-blockers for these patients would provide an excellent opportunity to improve their care and outcomes.

PMID:
10577326
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk