Impact of acute beta-blocker therapy for patients with non-ST-segment elevation myocardial infarction.
OBJECTIVE
Early use of beta-blockers is a quality indicator for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI), despite limited data from randomized clinical trials in this population. We sought to determine the impact of acute beta-blocker therapy on outcomes in patients with NSTEMI.


METHODS
We examined acute (<24 hours) beta-blocker use in 72,054 patients with NSTEMI from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) initiative at 509 US hospitals from 2001-2004. We analyzed patient and provider factors associated with beta-blocker use and the impact of beta-blocker therapy on unadjusted, risk-adjusted, and propensity matched outcomes in the overall sample and among selected high-risk subgroups.


RESULTS
A total of 82.5% of patients without documented contraindications received acute beta-blocker therapy. Factors strongly associated with acute beta-blocker use included prior beta-blocker use, higher presenting systolic blood pressure, lower heart rate, lack of signs of heart failure, and cardiology care. Acute beta-blocker use was associated with lower in-hospital mortality (unadjusted 3.9% vs 6.9%, P <.001, adjusted odds ratio 0.66, 95% confidence interval 0.60-0.72), lower adjusted mortality among most of 6 subgroups determined by propensity to receive acute beta-blockers, and lower adjusted mortality in patients with and without signs of heart failure and in those <80 years and those > or =80 years old.


CONCLUSIONS
The majority of NSTEMI patients receive acute beta-blocker therapy. Certain patient subgroups remain undertreated. Because treatment with acute beta-blockers was associated with improved clinical outcomes in nearly all patient subgroups assessed, broader use in patients with NSTEMI appears warranted.
Miller
Chadwick D
CD
Wake Forest University Health Sciences, Winston-Salem, NC, USA.
Roe
Matthew T
MT
Mulgund
Jyotsna
J
Hoekstra
James W
JW
Santos
Renato
R
Pollack
Charles V
CV
Ohman
E Magnus
EM
Gibler
W Brian
WB
Peterson
Eric D
ED
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
D000319:Adrenergic beta-Antagonists