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Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction

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Abstract

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, Wisconsin.

Patients/participants: All subjects (n=694) discharged alive from July 1, 1990, to June 30, 1991, who had a diagnosis of acute myocardial infarction were eligible. Of these, 250 had missing data, resulting in a final sample of 444.

Results: Twenty-nine percent of the 444 patients were prescribed beta blocker therapy on discharge. Characteristics 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 health insurance, 0.21 for chronic obstructive pulmonary disease, 0.46 for 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 blocker therapy was also influenced by receipt of other treatment modalities. The adjusted odds ratios were 0.23 for receipt of beta blocker therapy associated with myocardial revascularization, 0.18 for prescription on discharge of calcium channel blockers, and 0.22 for receipt of angiotensin-converting enzyme inhibitors.

Conclusion: A minority of patients discharged after acute myocardial infarction receive beta blocker therapy, and women are only half as likely as men to receive it, after controlling for other factors. Though there are no data relating to whether calcium channel blockers or angiotensin-converting enzyme inhibitors lessen the protective effect of beta blocker therapy post—acute myocardial infarction, it would appear that these agents are frequently being used in lieu of beta blocker therapy for post—acute myocardial infarction patients.

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References

  1. Deedwania PC, Carbajal EV. Secondary prevention after myocardial infarction. Too many choices, which ones work? [editorial]. Arch Intern Med. 1993;153:285–8.

    Article  PubMed  CAS  Google Scholar 

  2. Yusuf S, Wittes, J, Friedman L. Overview of results of randomized clinical trials in heart disease. I. Treatments following myocardial infarction. JAMA. 1988;260:2088–93.

    Article  PubMed  CAS  Google Scholar 

  3. Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335–71.

    Article  PubMed  CAS  Google Scholar 

  4. Anderson JL. Effects of beta-blocker on ventricular fibrillation threshold. In: Deedwania PC (ed). Beta-Blockers and Cardiac Arrhythmias. New York: Marcel Dekker, 1992;31–53.

    Google Scholar 

  5. Lichstein E. Effects of beta-blockers on cardiac arrhythmia in acute myocardial infarction: the BHAT experience. In: Deedwania P (ed). Beta-Blockers and Cardiac Arrhythmias. New York: Marcel Dekker, 1992;133–49.

    Google Scholar 

  6. Smith SC Jr, Gilpin E, Ahnve S, et al. Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. J Am Coll Cardiol. 1990;16:784–92.

    Article  PubMed  Google Scholar 

  7. Montague TJ, Ikuta RM, Wong Ry, Bay KS, Teo KK, Davies NJ. Comparison of risk and patterns of practice in patients older and younger than 70 years with acute myocardial infarction in a two year period (1987–1989). Am J Cardiol. 1991;68:843–7.

    Article  PubMed  CAS  Google Scholar 

  8. Gurwitz JH, Goldberg RJ, Chen Z, Gore JM, Alper JS. Beta-blocker therapy in acute myocardial infarction: evidence for underutilization in the elderly. Am J Med. 1992;93:605–10.

    Article  PubMed  CAS  Google Scholar 

  9. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med. 1989;32:406–12.

    Google Scholar 

  10. Maynard C, Litwin PE, Martin JS, Weaver WD. Gender differences in the treatment and outcome of acute myocardial infarction. Results from the Myocardial Infarction Triage and Intervention Registry. Arch Intern Med. 1992;152:972–6.

    Article  PubMed  CAS  Google Scholar 

  11. Krumholz HM, Douglas PS, Lauer MS, Pasternak RC. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for a gender bias? Ann Intern Med. 1992;116:785–90.

    PubMed  CAS  Google Scholar 

  12. Tobin JN, Wessertheir-Smoller S, Wexler JP, et al. Sex bias in considering coronary bypass surgery. Ann Intern Med. 1987;107:19–25.

    PubMed  CAS  Google Scholar 

  13. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325:221–5.

    Article  PubMed  CAS  Google Scholar 

  14. Pagley P, Yanzebski J, Goldberg R, et al. Gender differences in the treatment of patients with acute myocardial infarction. A multi-hospital community-based perspective. Arch Intern Med. 1993;153:625–9.

    Article  PubMed  CAS  Google Scholar 

  15. Ayanian JZ, Udvarhelyi IS, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993;269:2642–6.

    Article  PubMed  CAS  Google Scholar 

  16. Johnson P, Lee TH, Cook EF, Rouan GW, Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med. 1993;118:593–601.

    PubMed  CAS  Google Scholar 

  17. Willerson JT. Acute myocardial infarction. In: Wyngaarden J, Smith LH Jr (eds). Cecil Texbook of Medicine, 17th ed. Philadelphia: W. B. Saunders, Company, 1985;288.

    Google Scholar 

  18. Diseases of the heart and pericardium. In: Berkow R, Fletcher AJ (eds). Merck Manual of Diagnosis and Therapy. Rahway, NJ: Merck Sharp and Dohme Research Laboratories, 1987;498.

    Google Scholar 

  19. Pasternak R, Braunwald E, Alpert J. Acute myocardial infarction. In: Braunwald E, Isselbacher K, Petersdorf R, Wilson J, Martin J, Fauci A (eds). Harrison’s Principles of Internal Medicine, 11th ed. New York: McGraw-Hill, 1987;987.

    Google Scholar 

  20. Sokolow M, Massie B. Heart and great vessels. In: Schroeder SA, Krupp M, Trerney L, McPhee SJ (eds). Current Medical Diagnosis and Treatment. East Norwalk, CT: Appleton and Lange, 1989;235–6.

    Google Scholar 

  21. Beta-Blocker Therapy Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA. 1982;247:1707-l4.

    Article  Google Scholar 

  22. The Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med. 1981;304:801–7.

    Article  Google Scholar 

  23. Hjalmanson A, Elmfeldt D, Herlitz J, et al. Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomized trial. Lancet. 1981;2:823–7.

    Article  Google Scholar 

  24. Anderson MP, Bechsgaard P, Frederiksen J, et al. Effect of alprenolol in mortality among patients with definite or suspected acute myocardial infarction. Preliminary results. Lancet. 1979;2:865–8.

    Article  Google Scholar 

  25. Braveman PA, Egerter S, Bennett T, Showstack J. Differences in hospital resource allocation among sick newborns according to insurance coverage. JAMA. 1991;266:3300–8.

    Article  PubMed  CAS  Google Scholar 

  26. Weissman J, Epstein AM. Case mix and resource utilization by uninsured hospital patients in the Boston metropolitan area. JAMA. 1989;261:3572–6.

    Article  PubMed  CAS  Google Scholar 

  27. Spillman BC. The impact of being uninsured on utilization of basic health care services. Inquiry. 1992;29:457–66.

    PubMed  CAS  Google Scholar 

  28. Freeman HE, Blendon RJ, Aiken LH, Sudman S, Mullinix CF, Corey CR. Health Aff. 1987;6:6–18.

    Article  CAS  Google Scholar 

  29. Wenneker MB, Weissman JS, Epstein AM. The association of payer with utilization of cardiac procedures in Massachusetts. JAMA. 1990;264:1255–60.

    Article  PubMed  CAS  Google Scholar 

  30. Greenberg ER, Chute CG, Stukel T, et al. N Engl J Med. 1988;318:612–7.

    Article  PubMed  CAS  Google Scholar 

  31. Hafner-Eaton C. Physician utilization disparities between the uninsured and insured. JAMA. 1993;269:787–92.

    Article  PubMed  CAS  Google Scholar 

  32. Aday LA, Andersen RM. The national profile of access to medical care: where do we stand? Am J Public Health. 1984;74:1331–9.

    PubMed  CAS  Google Scholar 

  33. Woolhandler S, Himmelstein DU. Reverse targeting of preventive care due to lack of health insurance. JAMA. 1988;259:2872–4.

    Article  PubMed  CAS  Google Scholar 

  34. Hayward RA, Shapiro MF, Freeman HE, Corey CR. Who gets screened for cervical and breast cancer? Arch Intern Med. 1988;148:1177–81.

    Article  PubMed  CAS  Google Scholar 

  35. Kjekshus J, Gilpin E, Cali G, Blackey AR, Henning H, and Ross J Jr. Diabetic patients and beta blockers after acute myocardial infarction. Eur Heart J. 1990;11:43–50.

    PubMed  CAS  Google Scholar 

  36. Radack K, Deck C. β-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. Arch Intern Med. 1991;151:1769–76.

    Article  PubMed  CAS  Google Scholar 

  37. Johnston DL, Gebhardt VA, Donald A, Kostuk WJ. Comparative effects of propranolol and verapamil alone and in combination on left ventricular function and volumes in patients with chronic exertional angina: a double-blind, placebo-controlled, randomized, crossover study with radionuclide ventriculography. Circulation. 1983;68:1280–9.

    PubMed  CAS  Google Scholar 

  38. Pfeffer M, Braunwald E, Moye L, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 1992;327:669–77.

    Article  PubMed  CAS  Google Scholar 

  39. Nicklas J, Pitt B, Rogers W, et al. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685–91.

    Article  Google Scholar 

  40. The Multicenter Diltiazem Postinfarction Trial Research Group. The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med. 1988;319:385–92.

    Article  Google Scholar 

  41. The Israeli SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT): a randomized intervention trial of nifedipine in patients with acute myocardial infarction. Eur Heart J. 1988;9:354–64.

    Google Scholar 

  42. Wilcox R, Hampton J, Banks D, et al. Trial of early nifedipine in acute myocardial infarction: the TRENT Study. Br Med J. 1986;293:1204–8.

    CAS  Google Scholar 

  43. Gibson R. Current status of calcium channel-blocking drugs after Q wave and non-Q wave myocardial infarction. Circulation. 1989;80(suppl 6):IV107-IV119.

    PubMed  CAS  Google Scholar 

  44. Muller JE, Morrison J, Stone PH, et al. Nifedipine therapy for patients with threatened and acute myocardial infarction: a randomized, double-blind, placebo-controlled comparison. Circulation. 1984;69:740–7.

    PubMed  CAS  Google Scholar 

  45. Pasternak RC, Braunwald E. Acute myocardial infarction. In: Wilson JD, Braunwald E, Isselbacher KJ, et al. (eds). Harrison’s Principles of Internal Medicine, 12 ed. New York: McGraw-Hill, 1987;987.

    Google Scholar 

  46. Brigut R, Everitt DE. Beta-blockers and depression. Evidence against an association. JAMA. 1992;267:1783–7.

    Article  Google Scholar 

  47. Rosenson RS. The truth about beta blocker adverse effects—depression, claudication, and lipids. J Ambul Monit. 1993;6:163–71.

    Google Scholar 

  48. Fogari R, Zoppi A, Pasotti C, et al. Plasma lipids during chronic anti-hypertensive therapy with different β-blockers. J Cardiovasc Pharmacol. 1989;14(suppl 7):S28-S32.

    PubMed  Google Scholar 

  49. Greco PJ, Eisenberg JM. Changing physicians’ practices. N Engl J Med 1993;329:1271–3.

    Article  PubMed  CAS  Google Scholar 

  50. Baber NS, Lewis JA. Confidence in results of beta blocker postinfarction trials. Br Med J. 1982;284:1749–50.

    Article  CAS  Google Scholar 

  51. Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA. 1992;268:240–8.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. the Department of Internal Medicine, University of Texas Medical Branch, 77555-0460, Galveston, TX

    Shahid H. Sial MD, Jean L Freeman PhD & James S. Goodwin MD

  2. the Department of Medicine, University of Wisconsin Medical School, Milwaukee, Wisconsin

    Michael Malone MD, Richard Battiola MD & John Nachodsky BSc

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  1. Shahid H. Sial MD
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  6. James S. Goodwin MD
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Sial, S.H., Malone, M., Freeman, J.L. et al. Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction. J Gen Intern Med 9, 599–605 (1994). https://doi.org/10.1007/BF02600301

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