Key result
Beta-blocker therapy at discharge after myocardial infarction was associated with a lower rate of readmission for MI at 1 year compared to no beta-blocker therapy (1.0% vs 5.7%, p=0.02).
Why the study?
Evidence for long-term beta-blocker therapy after MI predates contemporary care, and declining discharge rates of beta-blockers were reported among MI patients between 2011 and 2015.
Does discharge with a β-blocker post-MI reduce mortality and readmissions compared to discharge without a β-blocker?
Observational (n=347)
No
Does discharge with a β-blocker post-MI reduce mortality and readmissions compared to discharge without a β-blocker?
Absolute Event Rate: 1% vs 5.7%
p-value: p=0.02
Discharge with a β-blocker post-MI is associated with a trend towards fewer readmissions for MI, though most patients discharged without a β-blocker had a justified clinical reason for non-use.
May support beta-blocker use at MI discharge; leaves open need for randomized confirmation.
BACKGROUND: Long term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a β-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. This retrospective observational study aimed to investigate the causes for discharge without a β-blocker and relate it to outcome, compared to patients discharged with a β-blocker. METHODS: MI-patients registered in Riks-HIA discharged without β-blocker during 2011-2015 (no-β-group) and a control group (β-group) comprised of patients discharged with β-blocker treatment between January 1 to December 31, 2013, were matched by RIKS-HIA criteria for β-blocker use. Clinical characteristics, date of death, readmission for MI, other cardiovascular events were collected from Riks-HIA and medical records. RESULTS: The no-β-group included 141 patients, where 65.2% had a justified reason for non-β-blocker use. The β-group included 206 patients. There was no difference in cardiovascular risk factor profile. There were a trend towards a higher number of readmissions for MI in the no-β-group was (n = 8 (5.7%) vs n = 2 (1.0%), p = 0.02), but not mortality (6 (4.3%) vs 2 (1.0%), p = 0.07) and combined readmission for angina pectoris, heart failure, arrhythmias or stroke/TIA (n = 23 (16.3%) vs n = 25 (12.1%), p = 0.27). CONCLUSION: A majority of the patients in the no-β-group had a justified absence of a β-blocker. β-blocker treatment post-MI showed a trend towards fewer readmissions for MI. But important quality information is lacking to make a firm conclusion of the effect on outcome.
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Hagsund et al. (2020) conducted an observational in Myocardial infarction (n=347). Beta-blocker therapy vs. No beta-blocker therapy was evaluated on Readmission for myocardial infarction at 1 year (p=0.02). Beta-blocker therapy at discharge after myocardial infarction was associated with a lower rate of readmission for MI at 1 year compared to no beta-blocker therapy (1.0% vs 5.7%, p=0.02).
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