November 2, 1999Annals of Internal Medicine
Early β-Blocker Therapy for Acute Myocardial Infarction in Elderly Patients
Why the study?
Does early beta-blocker therapy reduce in-hospital mortality in elderly patients hospitalized with acute myocardial infarction?
Population
58,165 Medicare beneficiaries ≥65 years of age hospitalized with acute myocardial infarction in 1994 and…
Comparison
Early beta-blocker therapy vs No early beta-blocker therapy
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
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Member takes
Implication
Supports early beta-blocker investigation in elderly AMI; does not support practice change absent randomized trials.
Key Points
- Determine the frequency of early beta-blocker administration, identify predictors of treatment decisions, and evaluate the association with in-hospital mortality in elderly patients hospitalized for acute myocardial infarction.
- Observational chart review study of N=58,165 Medicare beneficiaries aged 65 years or older without beta-blocker contraindications.
- Conducted across 4,414 nongovernment, acute care hospitals in the United States among patients hospitalized with acute myocardial infarction between 1994 and 1995.
- Only 28,256 of 58,165 patients (49%) received early beta-blocker therapy, and patients with the highest risk for in-hospital death were the least likely to receive treatment.
- Patients who received early beta-blocker therapy had significantly lower in-hospital mortality than those who did not (odds ratio 0.81, 95% CI 0.75 to 0.87) after adjustment for baseline characteristics.
Structured PICO
Does early beta-blocker therapy reduce in-hospital mortality in elderly patients hospitalized with acute myocardial infarction?
P
Population
58,165 Medicare beneficiaries ≥65 years of age hospitalized with acute myocardial infarction in 1994 and 1995 without contraindications to beta-blocker therapy, across 4,414 US hospitals.
I
Intervention
Early beta-blocker therapy
C
Comparator
No early beta-blocker therapy
O
Outcome
In-hospital mortalityhard clinical
Early beta-blocker therapy is associated with reduced in-hospital mortality in elderly AMI patients but is significantly underutilized in clinical practice.
Cite This Study
Krumholz et al. (1999) studied this question.