Beta-blockers after AMI in elderly diabetics were associated with lower one-year mortality (HR 0.77, 95% CI 0.67-0.88 for non-insulin-treated) without increased readmission for complications.
Cohort (n=45,308)
Yes
Does beta-blocker therapy reduce one-year mortality in elderly diabetic patients after acute myocardial infarction?
Beta-blocker therapy after acute myocardial infarction is associated with reduced one-year mortality in elderly diabetic patients without increasing the risk of readmission for diabetic complications.
Effect estimate: HR 0.77 (non-insulin diabetics), HR 0.87 (insulin diabetics) (95% CI 0.67-0.88 (non-insulin), 0.72-1.07 (insulin))
OBJECTIVES We sought to determine the use and association with one-year mortality of beta-blocker therapy for the treatment of acute myocardial infarction (AMI) in elderly diabetic patients and to examine whether beta-blocker therapy was associated with increased rates of hospital readmission for diabetic complications traditionally associated with beta-blockers. BACKGROUND Although many randomized trials have demonstrated that beta-blockers are effective in reducing mortality after AMI, some experts are concerned about the use of beta-blockers in diabetic patients. Little is known about the effectiveness and complication rate of beta-blocker therapy after AMI for elderly diabetics in community practice settings. METHODS We conducted a retrospective cohort study using the National Cooperative Cardiovascular Project, which contained data abstracted from hospital medical records of Medicare beneficiaries admitted with an AMI during 1994 and 1995. RESULTS Out of 45,308 patients without contraindications to beta-blocker therapy, 7.4% were insulin-treated diabetics and 18.5% were non-insulin-treated diabetics. Beta-blockers were prescribed at discharge for 45% of insulin-treated diabetics, 48.1% of non-insulin-treated diabetics and 51% of nondiabetics (p < 0.001). After adjusting for demographic and clinical factors, diabetics continued to be less likely to receive beta-blockers at discharge compared with nondiabetics (odds ratio OR for insulin-treated diabetics 0.88, 95% confidence interval CI 0.82 to 0.96; OR for non-insulin-treated diabetics 0.93, 95% CI 0.88 to 0.98). After adjusting for potential confounders, beta-blockers were associated with lower one-year mortality for insulin-treated diabetics (hazard ratio HR = 0.87, 95% CI 0.72 to 1.07), non-insulin-treated diabetics (HR = 0.77, 95% CI 0.67 to 0.88) and nondiabetics (HR = 0.87, 95% CI 0.80 to 0.94). Beta-blocker therapy was not significantly associated with increased six-month readmission rates for diabetic complications among diabetics and nondiabetics. CONCLUSIONS Beta-blockers are associated with a lower one-year mortality rate for elderly diabetic patients to a similar extent as for nondiabetics, without increased risk of readmission for diabetic complications. Increasing the use of beta-blockers in elderly diabetic patients represents an opportunity to improve the care and outcomes of these patients after AMI.
Chen et al. (Mon,) conducted a cohort in Acute myocardial infarction (AMI) in elderly diabetic patients (n=45,308). Beta-blocker therapy vs. No beta-blocker therapy was evaluated on One-year mortality (HR 0.77 (non-insulin diabetics), HR 0.87 (insulin diabetics), 95% CI 0.67-0.88 (non-insulin), 0.72-1.07 (insulin)). Beta-blockers after AMI in elderly diabetics were associated with lower one-year mortality (HR 0.77, 95% CI 0.67-0.88 for non-insulin-treated) without increased readmission for complications.
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