Beta-Blockers Underused In Older Patients After Heart Attacks, Major Study Of 45,000 Patients 65 Years Or Older Reveals

August 18, 1998

New Haven, Conn. -- 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.
-end-
Editor's Note: The study was sponsored by the Health Care Financing Administration, Department of Health and Human Services, and was undertaken as part of the National Cooperative Cardiovascular Project. The analysis was supported in part by a grant from the Patrick and Catherine Weldon Donaghue Medical Research Foundation. (The Journal of the American Medical Association, No. 280: 623-629, Aug. 19, 1998.)
-end-


Yale University

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.