title: Association between functional status and use and effectiveness of beta-blocker prophylaxis in elderly survivors of acute myocardial infarction.
abstract: OBJECTIVE
  To examine whether physical and cognitive impairments explain low use of beta-blockers in elderly patients and whether functionally impaired older adults have improved survival if a beta-blocker is prescribed at hospital discharge.
  
  
  METHODS
  Cross-sectional and retrospective cohort study.
  
  
  METHODS
  Acute care hospitals in the United States.
  
  
  METHODS
  National cohort of 45,370 elderly acute myocardial infarction survivors, with no chart-documented contraindications to beta-blocker treatment.
  
  
  METHODS
  The main outcome measures were beta-blocker prescription at hospital discharge and 1-year survival.
  
  
  RESULTS
  Fifty percent (n=22,683) of eligible patients were prescribed a beta-blocker at discharge. Older age and functional impairments (incontinence, mobility impairment, and cognitive impairment) were independently associated with decreased use of beta-blockers. The odds ratios for prescribing a beta-blocker at hospital discharge were 0.82 (95% confidence interval (CI)=0.77-0.86), 0.63 (95% CI=0.56-0.71), and 0.40 (95% CI=0.32-0.51) for persons with one, two, and three impairments, respectively, compared with those with no impairments. In survival analysis, patients prescribed a beta-blocker were 21% less likely than nonrecipients to die within 1 year of follow-up (relative risk=0.79, P=.0001). Similar survival benefit was observed in patients with and without functional impairments.
  
  
  CONCLUSIONS
  This study shows a strong association between functional impairment and the use of beta-blockers after acute myocardial infarction in elderly patients. The results suggest that increasing use of beta-blockers in this group provides an opportunity to improve outcomes.
authors.affiliation: Department of Medicine, School of Medicine, Yale University, New Haven, and Clinical Epidemiology Unit, Veterans Affairs Connecticuat Healthcare System, West Haven, Connecticut, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Vitagliano
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.forename: Alvan R
authors.initials: AR
authors.lastname: Feinstein
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D010351:Patient Discharge / Q000706:statistics & numerical data; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists