Beta-Blockers Underused in Older Patients After Heart Attacks, Major Study of 45,000 Patients 65 Years or Older Reveals

Beta-blockers are not prescribed for many older patients who could benefit from their use after heart attacks, according to an article in the Aug. 19 issue of The Journal of the American Medical Association (JAMA). In fact, the study found that only half of 45,000 patients who were ideal candidates for the possibly life-prolonging treatment were prescribed beta-blockers when they were released from the hospital.

“Given that mortality after acute myocardial infarction is high in the elderly and that beta-blockers reduce mortality in this group, our findings reveal an ample opportunity to improve the care and outcomes for such patients,” said Harlan M. Krumholz, M.D., from the Yale School of Medicine and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

Krumholz and his colleagues examined a database of Medicare beneficiaries that were 65 years old or older who had been discharged from the hospital after an acute myocardial infarction (sudden heart attack), a condition in which part of the heart muscle suddenly dies.

Anyone who has had such a heart attack is at increased risk to experience another in the first few years following his or her initial heart attack. Beta-blockers often reduce the risk of further damage to the heart muscle and thereby the risk of another, and potentially fatal, heart attack, Krumholz said.

The importance of beta-blockers as preventive therapy after acute myocardial infarction has been established in younger patients. This study found a similar benefit for Medicare beneficiaries 65 years old or older. Patients in the study receiving beta-blocker therapy at the time of discharge had a 14 percent lower risk of death at one year after discharge.

The study also showed the influence of the hospital as an appropriate setting for beginning this important preventative therapy, Krumholz said. Of the patients who were not receiving beta-blocker therapy when admitted, 43.5 percent began the therapy on or before being released from the hospital.

Specialists, as a whole, tended to be more likely to prescribe beta-blockers. “Patients admitted by cardiologists and internists were much more likely to be discharged receiving beta-blockers than those admitted by general or other types of physicians, demonstrating that opportunities for improvement are not equal among physician groups,” the researchers reported.

The use of beta-blockers varied throughout the country, with the New England region having significantly higher use than the rest of the country. Among states, the use of beta-blockers ranged from a low of 30.3 percent in Mississippi to a high of 77.1 percent in Connecticut. “Variation across the country is striking, but all areas can improve the care of such patients by increasing the appropriate use of beta-blockers,” Krumholz said.

The researchers concluded: “This study represents the most comprehensive evaluation of the use of beta-blockers in elderly survivors of acute myocardial infarction…. The results of our study reinforce the survival benefit associated with the use of beta-blockers and suggest the need for a national effort to address this issue.”

In addition to Krumholz, who is with the epidemiology and public health department at the Yale School of Medicine, researchers included Asefeh Heiat, M.D., and Martha J. Radford, M.D., of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation; Jersey Chen, B.A., of the cardiology section at the Yale School of Medicine; Yun Wang, M.S., Connecticut Peer Review Organization; and Thomas A Marciniak, M.D., Health Care Financing Administration, Baltimore.

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