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June 26, 1999BMJ1,521 citationsOpen Access

beta Blockade after myocardial infarction: systematic review and meta regression analysis

NFNick FreemantleJCJohn G.F. ClelandPYPhilip J. Young

Key Result

â blockers reduced all cause mortality by 23% in long term trials compared to control with an odds ratio of 0.77 (95% CI 0.69 to 0.85).

Study Design

Type

Meta-Analysis (n=54,234)

Blinding

null

Randomization

randomized

Multicenter

Yes

Structured PICO

Does beta blocker therapy reduce all cause mortality and reinfarction in patients with acute or past myocardial infarction?

P
Population
Patients who had a myocardial infarction (acute or past)
I
Intervention
Beta blockers (short-term acute treatment and long-term secondary prevention)
C
Comparator
Placebo or alternative treatment (control)
O
Outcome
All cause mortalityhard clinical

Long-term beta-blocker therapy significantly reduces all-cause mortality and non-fatal reinfarction in patients after myocardial infarction, whereas short-term acute use does not show a significant mortality benefit.

Main Result

Effect estimate: OR 0.77 (95% CI 0.69-0.85)

p-value: p=<0.001

Limitations

  • Underutilization of â blockers in practice despite significant benefits
  • Variation in study quality regarding follow-up and reporting standards
  • Inadequate evaluation of certain â blockers like atenolol for long term use.
  • Small numbers of patients in short-term trials led to many trials with no or few deaths
  • Only 21 of 34 comparisons provided data on reinfarction, resulting in wider confidence intervals and potential for reporting bias
  • Different definitions and reporting made comparison of treatment withdrawal between trials problematic

Abstract

beta Blockers are effective in long term secondary prevention after myocardial infarction, but they are underused in such cases and lead to avoidable mortality and morbidity.

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Cite This Study

Freemantle et al. (1999) conducted a meta-analysis in myocardial infarction (n=54,234). â blockers vs. control was evaluated on all cause mortality (OR 0.77, 95% CI 0.69-0.85, p=<0.001). â blockers reduced all cause mortality by 23% in long term trials compared to control with an odds ratio of 0.77 (95% CI 0.69 to 0.85).

synapsesocial.com/papers/69697d6d8374bfe05cda346ahttps://doi.org/10.1136/bmj.318.7200.1730
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