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Early β-Blocker Therapy for Acute Myocardial Infarction in Elderly Patients
- Harlan M. Krumholz, MD;
- Martha J. Radford, MD;
- Yun Wang, MS;
- Jersey Chen, BA; and
- Thomas A. Marciniak, MD
- From Yale University School of Medicine and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut; and the Health Care Financing Administration, Baltimore, Maryland.
Abstract
Background: Despite the evidence supporting the importance of early β-blocker therapy, this intervention has received little attention as an indicator of quality of care.
Objectives: To determine how often β-blockers are administered as early treatment of acute myocardial infarction in patients 65 years of age or older, to identify predictors of the decision to use β-blockers, and to evaluate the association between the early use of β-blockers and in-hospital 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 hospitalized with an acute myocardial infarction in 1994 and 1995, and did not have a contraindication to β-blocker therapy.
Measurements: Medical chart review to obtain information about the use of β-blockers, contraindications to these drugs, patient demographics, and clinical factors.
Results: Of the 58 165 patients (from a total of 4414 hospitals), 28 256 (49%) received early β-blocker therapy. Patients with the highest risk for in-hospital death were the least likely to receive therapy. Patients who received β-blockers had a lower in-hospital mortality rate than patients who did not receive β-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 β-blocker therapy was not used for 51% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a contraindication to this therapy. Increasing the early use of β-blockers for these patients would provide an excellent opportunity to improve their care and outcomes.
- Myocardial infarction
- Age factors
- Adrenergic β-antagonists
- Time factors
- Outcome assessment (health care)
Article and Author Information
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Grant Support: Dr. Krumholz is a Paul Beeson Faculty Scholar. The analyses on which this report is based were performed under contract 500-96-P549, titled “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, and the mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care and therefore required no special funding on the part of this Contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.
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Requests for Reprints: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, New Haven, CT 06520-8025; e-mail, harlan.krumholz{at}yale.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
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Current Author Addresses: Dr. Krumholz and Mr. Chen: Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, New Haven, CT 06520-8025.
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Dr. Radford: Center for Outcomes Research and Evaluation, Yale-New Haven Health System, 20 York Street, GB 415, New Haven, CT 06504.
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Mr. Wang: Qualidigm, 100 Roscommon Drive, Middletown, CT 06457.
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Dr. Marciniak: Health Care Financing Administration, 7500 Security Boulevard, Building S2-11-07, Baltimore, MD 21244-1850.
- Copyright ©2004 by the American College of Physicians
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