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Underutilization of Beta Blockers After Infarction in the Elderly
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Am Fam Physician. 1998 May 15;57(10):2530.
Beta-adrenergic blockers are known to reduce rates of mortality after myocardial infarction in older patients. Mendelson and Aronow conducted a retrospective study to investigate the use of beta blockers in elderly patients with a history of myocardial infarction or coronary artery disease.
The medical records of patients attending a hospital-based geriatrics clinic from January 1996 through March 1997 were reviewed to identify patients with a history of myocardial infarction or coronary artery disease. Physicians and consultants provided care to 233 patients (149 women and 84 men) with a history of myocardial infarction or coronary artery disease. The patients ranged in age from 67 to 96 years.
A total of 162 study subjects (70 percent) had a history of myocardial infarction, and 71 (30 percent) had documented coronary artery disease and atypical angina without a history of infarction. Only 38 (23 percent) of the 162 patients with a history of myocardial infarction were receiving beta blockers. Of the 124 patients not receiving beta blockers, only 19 (15 percent) had a contraindication to this medication. Thus, the prevalence of beta-blocker use in the patients with a history of myocardial infarction and no contraindications to beta blockers was 27 percent. Of 233 patients with documented coronary artery disease, 53 (23 percent) were receiving beta blockers. Beta blockers were contraindicated in 34 (19 percent) of these patients. The prevalence of beta-blocker use in the overall group with no contraindications was 27 percent.
The authors conclude that beta blockers are greatly underused in elderly patients who have a history of myocardial infarction. The authors note that beta blockers are known to decrease mortality in this population, as well as in elderly patients with complex ventricular arrhythmias associated with a history of myocardial infarction and normal or abnormal left ventricular ejection fraction. Data from the Beta-Blocker Heart Attack Trial showed that use of propranolol was associated with a 27 percent reduction in mortality in patients with congestive heart failure and a 25 percent reduction in mortality in patients without heart failure. The authors also note that the Beta-Blocker Pooling Project, which compiled data from nine studies involving 3,519 patients with heart failure at the time of an acute myocardial infarction, revealed that beta blockers produced a 25 percent reduction in mortality. The authors emphasize that beta blockers should be used instead of calcium channel blockers in patients with a history of myocardial infarction.
Mendelson G, Aronow WS. Underutilization of beta-blockers in older patients with prior myocardial infarction or coronary artery disease in an academic, hospital-based geriatrics practice. J Am Geriatr Soc. 1997 November;45:1360–1.
Copyright © 1998 by the American Academy of Family Physicians.
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