Early beta-blocker therapy for acute myocardial infarction in elderly patients

Background: Despite the evidence supporting the importance of early beta-bl ocker therapy, this intervention has received little attention as an indica tor of quality of care. Objectives: To determine how often beta-blockers are administered as early treatment of acute myocardial infarction in patients 65 years of age or old er, to identify predictors of the decision to use beta-blockers, and to eva luate the association between the early use of beta-blockers and in-hospita l mortality. Design: Observational study. Setting: Nongovernment, acute care hospitals in the United States. Patients: Medicare beneficiaries who were 65 years of age or older, were ho spitalized with an acute myocardial infarction in 1994 and 1995, and did no t have a contraindication to beta-blocker therapy. Measurements: Medical chart review to obtain information about the use of b eta-blockers, contraindications to these drugs, patient demographics, and c linical factors. Results: Of the 58 165 patients (from a total of 4414 hospitals), 28 256 (4 9%) received early beta-blocker therapy. Patients with the highest risk for in-hospital death were the least likely to receive therapy. Patients who r eceived beta-blockers had a lower in-hospital mortality rate than patients who did not receive beta-blockers (odds ratio, 0.81 [95% CI, 0.75 to 0.87]) , even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the two groups. Conclusions: Early beta-blocker therapy was not used for 51% of elderly pat ients who were hospitalized with an acute myocardial infarction and did not have a contraindication to this therapy. Increasing the early use of beta- blockers for these patients would provide an excellent opportunity to impro ve their care and outcomes.