title: beta-Blocker use following myocardial infarction: low prevalence of evidence-based dosing.
abstract: 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.
authors.affiliation: Northwestern University, Chicago, IL 60611, USA. j-goldberger@northwestern.edu
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.forename: Michael
authors.initials: M
authors.lastname: Cuffe
authors.forename: Alan
authors.initials: A
authors.lastname: Dyer
authors.forename: Yves
authors.initials: Y
authors.lastname: Rosenberg
authors.forename: Robert
authors.initials: R
authors.lastname: O'Rourke
authors.forename: Prediman K
authors.initials: PK
authors.lastname: Shah
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists
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