BETA-BLOCKER USE IN THE TREATMENT OF COMMUNITY-HOSPITAL PATIENTS DISCHARGED AFTER MYOCARDIAL-INFARCTION

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.