Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction

Sial, Shahid H.; Malone, Michael L.; Freeman, Jean L.; Battiola, Richard J.; Nachodsky, John; Goodwin, James S.

doi:10.1007/bf02600301

Cited by 39 publications

(32 citation statements)

References 45 publications

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“…10 In the current study, we also found that the use of evidence-based drug therapies decreased with increasing patient age, a finding that is consistent with previous studies. 16,17 In this regard, our findings build upon those prior studies, by demonstrating that the importance of age in influencing prescribing patterns persists after adjustment for physician, hospital and community characteristics. Similarly, the impact of the specialty of the attending physician on the use of evidence-based drug therapies builds upon previous evidence of lower prescribing rates of β-blockers among general practitioners and family practitioners than among cardiology specialists.…”

Section: Discussionsupporting

confidence: 82%

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction

Austin¹,

Tu²,

Ko³

et al. 2008

Canadian Medical Association Journal

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Section: Discussionsupporting

confidence: 82%

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction

Austin¹,

Tu²,

Ko³

et al. 2008

Canadian Medical Association Journal

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“…4,6,8,9,14 Some of the estimates were even lower than what we report. For example, Soumerai and colleagues 9 merged 3 large administrative databases with data from 1987 through 1992 to examine the use of ␤-blockers among elderly survivors of AMI from New Jersey.…”

Section: Commentcontrasting

confidence: 82%

National Use and Effectiveness of β-Blockers for the Treatment of Elderly Patients After Acute Myocardial Infarction

Krumholz

Radford²,

Wang³

et al. 1998

JAMA

457

253

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Context.-Despite the importance of ␤-blockers for secondary prevention after acute myocardial infarction (AMI), several studies have suggested that they are substantially underutilized, particularly in older patients.Objectives.-To describe the contemporary national pattern of ␤-blocker prescription at hospital discharge among patients aged 65 years or older with an AMI, to identify the most important predictors of the prescribed use of ␤-blockers at discharge, and to determine the independent association between ␤-blockers at discharge and mortality in clinical practice.Design.-Retrospective cohort study using data created from medical charts and administrative files.Setting.-Acute care nongovernmental hospitals in the United States.Patients.-National cohort of 115 015 eligible patients aged 65 years or older who survived hospitalization with a confirmed AMI in 1994 or 1995.Main Outcome Measures.-␤-Blocker as a discharge medication and mortality in the year after discharge.Results.-Among the 45 308 patients without contraindications to ␤-blockers, 22 665 (50.0%) had a ␤-blocker as a discharge medication. There was significant variation by state, ranging from 30.3% to 77.1%. Of the 36 795 patients who were not receiving ␤-blocker therapy on admission, 16 006 (43.5%) had therapy initiated on or before discharge. Demographic and clinical variables explained relatively little of the variation in the initiation of ␤-blocker therapy. The prescribed use of calcium channel blockers at discharge had a strong negative association with the use of ␤blockers (odds ratio [OR] of ␤-blocker use, 0.25; 95% confidence interval [CI], 0.24-0.26). The New England region had significantly higher use of ␤-blocker therapy than the rest of the country. Compared with cardiologists, internists had similar rates (OR, 0.94; 95% CI, 0.90-1.00) and general and family practice physicians had lower rates (OR, 0.78; 95% CI, 0.73-0.83). After adjusting for potential confounders, ␤-blockers were associated with a 14% lower risk of mortality at 1 year after discharge. The association with lower mortality was present in subgroups stratified by age, sex, and left ventricular ejection fraction.Conclusions.-Many ideal patients for ␤-blocker therapy are not prescribed these drugs at discharge following AMI. The clinical and demographic characteristics of the patients do not explain much of the variation in the treatment pattern. Geographic factors and physician specialty are independently associated with the decision to use ␤-blockers. Elderly patients who are prescribed ␤-blockers at discharge have a better survival rate, consistent with the findings of randomized controlled trials of younger and lower-risk populations.

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“…Similar to the findings of another investigator with a similar-sized cohort, 18 logistic regression analysis did not suggest any association with race. But the small number of black patients did not provide adequate power to examine this question.…”

Section: Discussionsupporting

confidence: 88%

“…1,9,[14][15][16][17][18][19][20][21][22] As seen in previous studies by other investigators, 23 is unlikely to account for increase in use of BBs, because this group has consistently been found to be undertreated. The increase in prescription of BBs prehospital, in hospital, and at discharge is most likely the result of many quality improvement measures that occurred between the study periods.…”

Section: Discussionmentioning

confidence: 71%

Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction

et al. 2004

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Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction

Cited by 39 publications

References 45 publications

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction

National Use and Effectiveness of β-Blockers for the Treatment of Elderly Patients After Acute Myocardial Infarction

Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction

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