Beta-blocker Medicines for Older People after Heart Attack

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The summary below is from the full report titled "Early -Blocker Therapy for Acute Myocardial Infarction in Elderly Patients." It is in the 2 November 1999 issue of Annals of Internal Medicine (volume 131, pages 648-654). The authors are H.M. Krumholz, M.J. Radford, Y. Wang, J. Chen, and T.A. Marciniak.

What is the problem and what is known about it so far?

Beta-blockers, a type of medicine that slows the heart rate, improve how well people do after a coronary heart attack. The earlier that heart attack patients get ß-blockers, the better they seem to do. Ideally, doctors should prescribe these medicines as soon after the heart attack as possible, but this may not be happening as often as it should.

Why did the researchers do this particular study?

The researchers wanted to find out three things: 1) How often did patients older than 65 years of age actually get early ß-blocker therapy during hospitalization for a heart attack? 2) What factors were linked to early use of ß-blockers? 3) Were patients who got early ß-blocker therapy after a heart attack less likely to die during the hospital stay than patients who didn't get these drugs?

Who was studied?

58,165 persons who were 65 years old or older, had Medicare insurance, were hospitalized with a heart attack during 1994 or 1995, and had no reason why they should not get a ß-blocker written in their charts. These patients were in 4414 hospitals across the United States.

How was the study done?

The researchers examined each patient's hospital chart to collect information about the patient, his or her medical condition, any reasons why the patient should not have gotten ß-blockers, whether and when the patient got ß-blockers, and whether the patient died during the hospital stay. They then compared the patients who did get ß-blockers with those who did not.

What did the researchers find?

Just under half of the patients got ß-blockers during hospitalization. Patients who were older, female, or nonwhite were the least likely to get these medicines. Patients who got ß-blockers were also more likely to get other types of therapy, such as aspirin, known to improve heart attack outcomes. Patients who got ß-blockers were more likely to live long enough to leave the hospital after the heart attack than those who did not get these drugs. The benefit of ß-blockers remained even after the researchers accounted for other factors that might have affected how well the patients did.

What were the limitations of the study?

The researchers depended on the hospital charts for all of the information on patients. Possibly, some of the patients had good reasons for not getting ß-blockers, but their doctors and nurses just did not write down the reasons in the charts. Also, the results might not be the same for people with heart attacks who are younger than 65 years of age, or for patients who do not have Medicare insurance.

What are the implications of the study?

Many older heart attack patients who could have received ß-blockers during hospitalization for heart attacks did not get them. This presents a problem because patients who get this medicine are more likely to live long enough to leave the hospital than are patients who don't receive this treatment.