Remember beta-blockers for older MI patients
Study: 21% of eligible patients receive treatment
When developing clinical paths for myocardial infarction (MI), don’t forget to include beta-blocker therapy in elderly patients. A new study from Harvard Medical School in Boston indicates that beta-blockers are underused in older MI patients, leading to a higher mortality rate and other adverse outcomes.1 The study found that of 3,737 post-MI Medicare patients considered eligible for beta-blocker therapy, only 21% received it within the 90 days following hospital discharge. In addition, only 48% of patients who were taking beta-blockers before having an MI continued to receive them after discharge.
The mortality rate for beta-blocker recipients was 43% less than for nonrecipients, the study also found, and beta-blocker recipients were rehospitalized 22% less often than nonrecipients.
"Patients who didn’t get beta-blockers had more deaths and cardiac hospitalizations over two years," says Stephen B. Soumerai, ScD, lead author of the study and associate professor at the Harvard Medical School and Harvard Pilgrim Health Care.
He says beta-blockers are recommended by authorities such as the American College of Cardiology in Bethesda, MD, and the American Heart Association in Dallas for post-MI patients to prevent recurrent MI.2 So why the reluctance to prescribe them?
"There are a lot of anecdotal reports from cardiologists and other physicians that suggest some answers," Soumerai says.
First, he says, because beta-blockers are "older drugs," they haven’t been well-promoted recently. Second, he says many physicians have concerns about side effects such as depression and fatigue, although those side effects have been "completely debunked" as "myths," notes Soumerai.
"Now it’s known pretty conclusively that the vast majority of elderly patients can be maintained on beta-blockers at low doses with minimal or no side effects," he explains.
"Everybody should be on a beta-blocker unless they have a specific contraindication" such as bradycardia, asthma, or severe hypotension, Soumerai adds.
He says clinicians developing clinical paths should strive to make beta-blockers part of the patient’s therapy after discharge.
"This should not be the exception it should be the rule," Soumerai says.
References
1. Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277:115-121.
2. Ryan TJ, Anderson JL, Antman EM, et al. American College of Cardiology/American Heart Association guidelines for the management of patients with acute myocardial infarction. J Am Coll Cardiol 1006; 28:1,328-1,428.
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