beta-Blocker use following myocardial infarction: low prevalence of evidence-based dosing.
BACKGROUND
Quality improvement programs have shown increased use of beta-blockers post-myocardial infarction (MI), but there are no data on whether appropriate doses are administered.


METHODS
In a prospective registry that enrolled consecutive patients with MI, we evaluated beta-blocker dosing at discharge after MI and 3 weeks later and assessed clinical predictors for treatment with very low doses. We studied 1,971 patients (70.8% male) with a mean age of 63.9 +/- 13.7 years, of whom 48.2% had an ST-elevation MI.


RESULTS
beta-Blocker utilization rates following MI were 93.2% at discharge: 20.1% received <25% of target dose, 36.5% received 25% of target dose, 26.4% received 26% to 50% of target dose, and 17.0% received >50% of target dose. Between discharge and 3 weeks, 76.4% had no change in beta-blocker dose, with 11.9% and 11.6% having their dose reduced and increased, respectively. Absence of hypertension, acute percutaneous coronary intervention, older age, and no angiotensin-converting enzyme inhibitor therapy were consistent predictors of treatment with very low beta-blocker doses.


CONCLUSIONS
Underdosing of beta-blockers is highly prevalent among patients post-MI. This represents an important opportunity in quality improvement for the care of patients who have suffered an MI.
Goldberger
Jeffrey J
JJ
Northwestern University, Chicago, IL 60611, USA. j-goldberger@northwestern.edu
Bonow
Robert O
RO
Cuffe
Michael
M
Dyer
Alan
A
Rosenberg
Yves
Y
O'Rourke
Robert
R
Shah
Prediman K
PK
Smith
Sidney C
SC
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care
D000319:Adrenergic beta-Antagonists
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