Practical considerations of beta-blockade in the management of the post-myocardial infarction patient.
Acute myocardial infarction (AMI) is a major cause of death and disability in the United States that affects an estimated total of 1.5 million men and women each year. Despite significant advances in pharmacologic and interventional therapies, 25% of men and 38% of women still die within 1 year of the acute event. Beta-blockers have been shown to significantly decrease the risk of morbidity and mortality in patients after an AMI. National guidelines recommend that all patients with AMI may be started on beta-blocker therapy and continued indefinitely, unless absolutely contraindicated or not tolerated. However, a substantial portion of eligible AMI survivors are not prescribed beta-blockers in the hospital after an acute event or upon hospital discharge. In addition, patients with AMI are often treated with agents whose long-term use has not been shown effective and for which optimal dosing has not been defined. This paper will discuss the background of beta-blocker use for the treatment of AMI, discuss the rationale for choosing specific agents, and present protocols for initiating or switching to evidence-based therapies.
Fonarow
Gregg C
GC
Ahmanson-UCLA Cardiomyopathy Center, The David Geffen School of Medicine, UCLA, 90095-1679, USA. gfonarow@mednet.ucla.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000465:Algorithms; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists