Relation of patient age and mortality to reported contraindications to early beta-blocker use for non-ST-elevation acute coronary syndrome.
We evaluated the reported contraindications to early beta-blocker use and associated mortality within and across patient age groups. Contraindications to early beta-blocker use were evaluated in patients with non-ST-elevation acute coronary syndrome in 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 from February 2003 to December 2006. The prevalence, reasons, and trends in the contraindications were evaluated by age (<or=65, 66 to 74, and >or=75 years). The associations between the reported contraindications and in-hospital mortality were determined within and compared across age groups using the logistic generalized estimating equations method, adjusting for baseline patient characteristics. Of 112,448 patients, 11,711 (10.4%) had a reported contraindication to early beta-blocker use. The prevalence varied by age (<or=65, 7.9%; 66 to 74, 10.6%; and >or=75, 13.4%; p <0.0001). No significant changes were seen over time, except for a small increase in patients <or=65 years (p = 0.001). Among the hospitals with >40 patients in the registry, the median hospital level rate of reported contraindications was 9.9% (interquartile range 6.7% to 14.3%). The distribution of rates was more widespread among the hospitals' older versus younger patients. In all age groups, a statistically significant greater association was found with in-hospital mortality in those with reported contraindications versus those without contraindications who received a beta blocker (adjusted odds ratio 2.81, 95% confidence interval 2.28 to 3.46; adjusted odds ratio 2.50, 95% confidence interval 2.07 to 3.03; adjusted odds ratio 2.11, 95% confidence interval 1.88 to 2.37, for ages <or=65, 66 to 74, and >or=75 years, respectively). The strength of the association was similar across all age groups (interaction p = 0.19). The reported contraindications to early beta-blocker use were common and increased with age. The contraindications were independently associated with greater in-hospital mortality, underscoring the importance of accurately identifying contraindications. In conclusion, the results did not indicate any disparity in reporting the contraindications according to patient age.
Allen LaPointe
Nancy M
NM
Duke Clinical Research Institute, Durham, North Carolina, USA. allen003@mc.duke.edu
Chen
Anita Y
AY
Roe
Matthew T
MT
Cohen
David J
DJ
Diercks
Deborah B
DB
Hoekstra
James W
JW
Fesmire
Francis M
FM
Gibler
W Brian
WB
Ohman
E Magnus
EM
Peterson
Eric D
ED
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000453:epidemiology; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists