Calcium channel blockers and mortality in elderly patients with myocardial infarction.
BACKGROUND
Although calcium channel blockers are a useful therapy in relieving angina, lowering blood pressure, and slowing conduction of atrial fibrillation, growing evidence has cast doubt on their safety in patients with coronary disease.


OBJECTIVE
To examine the association between calcium channel blocker therapy at hospital discharge and mortality in a population-based sample of elderly patients hospitalized with acute myocardial infarction.


METHODS
Retrospective cohort study using data from medical charts and administrative files.


METHODS
All acute care hospitals in 46 states.


METHODS
All Medicare patients with a principal diagnosis of acute myocardial infarction consecutively discharged from the hospital alive during 8-month periods between 1994 and 1995 (N = 141,041).


METHODS
Mortality at 30 days and 1 year.


RESULTS
Calcium channel blockers were widely prescribed at hospital discharge to elderly patients with myocardial infarction between 1994 and 1995 (n = 51,921), the most commonly prescribed being diltiazem (n = 21,175), nifedipine (n = 12,670), amlodipine (n = 11,683), and verapamil (n = 3639). After adjusting for illness severity and concomitant medication use, patients who were prescribed calcium channel blockers at hospital discharge did not have increased risk for 30-day or 1-year mortality, with the exception of the few (n = 116) treated with bepridil. Bepridil differs from other calcium channel blockers because of its tendency to prolong repolarization, and its association with proarrhythmic effects in elderly patients.


CONCLUSIONS
We did not identify a mortality risk in a large consecutive sample of elderly patients with myocardial infarction, which supports the need for additional prospective trials examining calcium channel blocker therapy for ischemic heart disease.
Jollis
J G
JG
Duke Clinical Research Institute, Duke University, Durham, NC, USA. james.jollis@duke.edu
Simpson
R J
RJ
Chowdhury
M K
MK
Cascio
W E
WE
Crouse
J R
JR
Massing
M W
MW
Smith
S C
SC
D000368:Aged; D000369:Aged, 80 and over; D017311:Amlodipine / Q000627:therapeutic use; D015764:Bepridil / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004110:Diltiazem / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D009543:Nifedipine / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014700:Verapamil / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D017311:Amlodipine; D015764:Bepridil; D014700:Verapamil; D004110:Diltiazem; D009543:Nifedipine