Effectiveness of beta-blocker therapy after acute myocardial infarction inelderly patients with chronic obstructive pulmonary disease or asthma

OBJECTIVES We evaluated the use and effectiveness of beta-blocker therapy a fter acute myocardial infarction (AMI) for elderly patients with chronic ob structive pulmonary disease (COPD) or asthma. BACKGROUND Because patients with COPD and asthma have largely been excluded from clinical trials of beta-blocker therapy for AMI, the extent to which these patients would benefit from beta-blocker therapy after AMI is not wel l defined. METHODS Using data from the Cooperative Cardiovascular Project, we examined the relationship between discharge use of beta-blockers and one-year morta lity in patients with COPD or asthma who were not using beta-agonists, pati ents with COPD or asthma who were concurrently using beta-agonists and pati ents with evidence of severe disease (use of prednisone or previous hospita lization for COPD or asthma) compared with patients without COPD or asthma. RESULTS Of 54,962 patients without contraindications to beta-blockers, pati ents with COPD or asthma (20%) were significantly less likely to be prescri bed beta-blockers at discharge after AMI. After adjusting for demographic a nd clinical factors, we found that beta-blockers were associated with lower one-year mortality in patients with COPD or asthma who were not on beta-ag onist therapy (relative risk [RR] = 0.85, 95% confidence interval [CI] 0.73 to 1.00), similar to patients without COPD or asthma (RR = 0.86, 95% CI 0. 81 to 0.92). A survival benefit for beta-blockers was not found among patie nts concurrently using beta-agonists or with severe COPD or asthma. CONCLUSIONS Beta-blocker therapy after AMI may be beneficial for CORD or as thma patients with mild disease. A survival benefit was not found for elder ly AMI patients with more severe pulmonary disease. (J Am Coll Cardiol 2001 ;37:1950-6) (C) 2001 by the American College of Cardiology.