Beta-blockers are not prescribed for many older patients who could benefit from their use after heart attacks, according to an article in the Aug. 19 issue of The Journal of the American Medical Association (JAMA). In fact, the study found that only half of 45,000 patients who were ideal candidates for the possibly life-prolonging treatment were prescribed beta-blockers when they were released from the hospital.
"Given that mortality after acute myocardial infarction is high in the elderly and that beta-blockers reduce mortality in this group, our findings reveal an ample opportunity to improve the care and outcomes for such patients," says Dr. Harlan M. Krumholz, assistant professor of medicine (cardiology) and epidemiology at the School of Medicine, who is also affiliated with the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.
Krumholz and his colleagues examined a database of Medicare beneficiaries age 65 or older who had been discharged from the hospital after an acute myocardial infarction (sudden heart attack), a condition in which part of the heart muscle suddenly dies.
Anyone who has had such a heart attack is at increased risk to experience another in the first few years following his or her initial heart attack, explains Krumholz, adding that beta-blockers often reduce the risk of further damage to the heart muscle and thereby the risk of another, and potentially fatal, heart attack. In fact, the importance of beta-blockers as preventive therapy after acute myocardial infarction has been established in younger patients.
The latest study showed that elderly patients who received beta-blocker therapy at the time of discharge had a 14 percent lower risk of death at one year after discharge.
The research also showed the influence of the hospital as an appropriate setting for beginning this preventative therapy, notes Krumholz. Of the patients who were not receiving beta-blocker therapy when admitted, 43.5 percent began the therapy upon or before being released from the hospital.
Specialists, as a whole, tended to be more likely to prescribe beta-blockers. "Patients admitted by cardiologists and internists were much more likely to be discharged receiving beta-blockers than those admitted by general or other types of physicians, demonstrating that opportunities for improvement are not equal among physician groups," the researchers report.
In addition to Krumholz, who is also with the medical school's department of epidemiology and public health and director of the Robert Wood Johnson Clinical Scholars program, researchers included Drs. Asefeh Heiat and Martha J. Radford of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation; Jersey Chen of the cardiology section at the School of Medicine; Yun Wang of the Connecticut Peer Review Organization; and Dr. Thomas A. Marciniak of the Health Care Financing Administration in Baltimore.
The study was sponsored by the Health Care Financing Administration,
Department of Health and Human Services, and was undertaken as part of the
National Cooperative Cardiovascular Project. The analysis was supported in
part by a grant from the Patrick and Catherine Weldon Donaghue Medical
Research Foundation.
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