title: Underuse of beta-blockers following myocardial infarction: a tale of two cities.
abstract: OBJECTIVE
  To measure factors associated with underuse of beta-blocker therapy after myocardial infarction (MI).
  
  
  METHODS
  The Newcastle and Perth collaborating centres of the World Health Organization (WHO) MONICA project (to MONItor trends and determinants of Cardiovascular disease) systematically evaluated all patients admitted to hospital in their respective regions with possible MI. A total of 1766 patients in Newcastle and 4,503 patients in Perth, discharged from hospital after confirmed MI from 1985 to 1993, were studied. Rates of beta-blocker use before and after hospital discharge were evaluated and correlates of beta-blocker use determined.
  
  
  RESULTS
  Beta-blocker use was similar in Newcastle and Perth before MI (21% of patients in each centre). During hospital admission, beta-blocker therapy was initiated nearly twice as frequently in Perth compared with Newcastle (66 vs 36%, respectively) and more patients were discharged from hospital on beta-blockers in Perth (68%) than in Newcastle (45%). The main factors associated with underuse of beta-blockers in multivariate analysis were geographical centre (odds ratio (OR) for Newcastle compared with Perth 0.3; 95% confidence interval (CI) 0.3-0.3), a history of previous MI (OR 0.6, 95% CI 0.5-0.7), admission to hospital in earlier years (OR 0.4, 95% CI 0.3-0.4 for years 1985-87 compared with years 1991-93), diabetes (OR 0.6, 95% CI 0.5-0.8) and the concomitant use of diuretics (OR 0.5, 95% CI 0.4-0.6) and calcium antagonists (OR 0.6, 95% CI 0.5-0.8).
  
  
  CONCLUSIONS
  Underuse of beta-blockers after MI was strongly related to hospital prescribing patterns and not to community use of beta-blockers. Underuse occurred in patients with diabetes and in patients with left ventricular dysfunction, patients who stand to benefit most from beta-blocker use following MI.
authors.affiliation: Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: P
authors.initials: P
authors.lastname: McElduff
authors.forename: A J
authors.initials: AJ
authors.lastname: Dobson
authors.forename: K D
authors.initials: KD
authors.lastname: Jamrozik
authors.forename: M S
authors.initials: MS
authors.lastname: Hobbs
authors.forename: J W
authors.initials: JW
authors.lastname: Leitch
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D001315:Australia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'
chemical_list: D000319:Adrenergic beta-Antagonists