Beta blockade withheld in AMI survivors
Beta blockade withheld in AMI survivors
Contraindicated patients benefit from beta-blockers
According to a recent study by the Health Care Financing Administration, only a third of acute myocardial infarction (AMI) patients receive beta-blockers. Cooperative Cardiovascular Project (CCP) investigators abstracted the medical records of more than 200,000 AMI patients and compared mortality between those treated with beta-blockers and those who went untreated during two years after their AMIs.1
Though physicians know long-term administration of beta-blockers to patients after AMI improves survival, many, the investigators conjecture, are reluctant to administer the drug to older, chronic pulmonary disease, left ventricular dysfunction, or non-Q-wave AMI patients.
Records showed that 34% of patients received beta-blockers. The percentage was even lower among the very elderly, blacks, patients with the lowest ejection fractions, heart failure, chronic obstructive pulmonary disease, elevated serum creatinine concentrations, and Type 1 diabetes.
Mortality was lower in every subgroup of patients treated with beta-blockade than in untreated patients. In patients with AMI and no complications, treatment with beta-blockers was associated with a 40% reduction in mortality.
Mortality was also reduced by 40% in patients with non-Q-wave infarction and those with chronic obstructive pulmonary disease. In blacks, patients 80 years old or older, those with a below 20% left ventricular ejection fraction, serum creatinine concentration greater than 1.4 mg per deciliter, and diabetes had less of a reduction in mortality.
However, given the higher overall mortality rates in those subgroups, the absolute reduction in mortality was similar to or greater than that among patients with no specific risk factors.
The investigators concluded that after AMI, patients with conditions that are often considered contraindications to beta-blockade — heart failure, pulmonary disease, and older age — and those with nontransmural infarction benefit from beta-blocker therapy.
Reference
1. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339:489-97.
Recommended reading
Radford MJ, Krumholz HM. Beta-blockers after myocardial infarction — for few patients or many? N Engl J Med 1998; 339:551-553.
Krumholz HM, et al. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction. JAMA 1998; 280:623-629.
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