Sh. Sial et al., BETA-BLOCKER USE IN THE TREATMENT OF COMMUNITY-HOSPITAL PATIENTS DISCHARGED AFTER MYOCARDIAL-INFARCTION, Journal of general internal medicine, 9(11), 1994, pp. 599-605
Objective: To explore the reasons for underutilization of beta blocker
treatment after acute myocardial infarction. Design: A retrospective
chart review. Setting: Two large community hospitals in Milwaukee, Wis
consin. Patients/participants: All subjects (n = 694) discharged alive
from July 1, 1990, to June 30, 1991, who had a diagnosis of acute myo
cardial infarction were eligible. Of these, 250 had missing data, resu
lting in a final sample of 444. Results: Twenty-nine percent of the 44
4 patients were prescribed beta blocker therapy on discharge. Characte
ristics of the patients and their treatment associated with receipt of
beta blocker therapy were identified with a logistic regression model
. The adjusted odds ratios were 0.52 for female gender, 0.34 for no he
alth insurance, 0.21 for chronic obstructive pulmonary disease, 0.46 f
or congestive heart failure, 0.28 for atrioventricular block, 1.86 for
hypertension, 1.93 for chest pain during acute myocardial infarction,
and 4.65 for prehospital beta blocker use. Prescription of beta block
er therapy was also influenced by receipt of other treatment modalitie
s. The adjusted odds ratios were 0.23 for receipt of beta blocker ther
apy associated with myocardial revascularization, 0.18 for prescriptio
n on discharge of calcium channel blockers, and 0.22 for receipt of an
giotensin-converting enzyme inhibitors. Conclusion: A minority of pati
ents discharged after acute myocardial infarction receive beta blocker
therapy, and women are only half as likely as men to receive it, afte
r controlling for other factors. Though there are no data relating to
whether calcium channel blockers or angiotensin-converting enzyme inhi
bitors lessen the protective effect of beta blocker therapy post-acute
myocardial infarction, it would appear that these agents are frequent
ly being used in lieu of beta blocker therapy for post-acute myocardia
l infarction patients.