title: Communitywide trends in the use and outcomes associated with beta-blockers in patients with acute myocardial infarction: the Worcester Heart Attack Study.
abstract: BACKGROUND
  Despite the benefits associated with beta-blocker therapy in patients with acute myocardial infarction (AMI), limited recent data are available describing the extent of use of this therapy and the associated hospital and long-term outcomes, particularly from the perspective of a population-based study. Data are also limited about the characteristics of patients with AMI who do not receive beta-blockers. This study examines more than 2 decades of trends in the use of beta-blockers in hospitalized patients with AMI.
  
  
  METHODS
  Communitywide study of 10,374 patients hospitalized with confirmed AMI in all metropolitan Worcester hospitals during 12 annual periods between 1975 and 1999.
  
  
  RESULTS
  There was a marked increase in the use of beta-blockers in hospitalized patients between 1975 (11%) and 1999 (82%). Older patients, women, and patients with comorbidities were significantly less likely to be treated with beta-blockers. After controlling for other prognostic factors, patients treated with beta-blockers were less likely to develop heart failure (adjusted odds ratio [OR], 0.58; 95% confidence interval [CI], 0.53-0.63), cardiogenic shock (OR, 0.46; 95% CI, 0.39-0.54), and primary ventricular fibrillation (OR, 0.84; 95% CI, 0.65-1.08) and were less likely to die (OR, 0.26; 95% CI, 0.22-0.29) during hospitalization than were patients who did not receive this therapy. Patients who used beta-blockers during hospitalization had significantly lower death rates after hospital discharge.
  
  
  CONCLUSIONS
  The results of this observational study demonstrate encouraging trends in the use of beta-blockers in hospitalized patients with AMI and document the benefits to be gained from this treatment.
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Mass, USA.
authors.forename: Helme
authors.initials: H
authors.lastname: Silvet
authors.forename: Frederick
authors.initials: F
authors.lastname: Spencer
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists