Beta-blocker therapy in acute myocardial infarction: evidence for underutilization in the elderly.
OBJECTIVE
To assess the impact of patient age on the use of beta-blocker therapy in the management of acute myocardial infarction.


METHODS
The population studied consisted of 4,762 patients hospitalized with validated acute myocardial infarction in 16 hospitals in the Worcester, Massachusetts, Standard Metropolitan Statistical Area during the years 1975, 1978, 1981, 1984, 1986, and 1988. Logistic regression analysis was employed to control for relevant demographic and clinical variables in evaluating the independent effect of patient age as a determinant of receipt of beta-blocker therapy during the hospitalization.


RESULTS
A consistent trend toward reduced use of beta-blocker therapy in older patients was demonstrated. After adjustment for demographic and clinical variables (gender; prior history of angina, hypertension, or diabetes mellitus; myocardial infarction characteristics; complications including congestive heart failure and shock; and use of digoxin and diuretics), odds ratios for receipt of beta-blocker therapy relative to patients less than 55 years of age were 0.61 for those 55 to 64; 0.52 for those 65 to 74; 0.36 for those 75 to 84; and 0.26 for those 85 or older. Analyses performed for each study year demonstrated results consistent with those for the overall study population.


CONCLUSIONS
The results of this population-based study suggest that there are substantial opportunities for expanded use of beta-blocker therapy in elderly patients who have sustained an acute myocardial infarction.
Gurwitz
J H
JH
Department of Medicine, University of Massachusetts Medical School, Worcester.
Goldberg
R J
RJ
Chen
Z
Z
Gore
J M
JM
Alpert
J S
JS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004363:Drug Utilization; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists