 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Beta-blocker Medicines for Older People after Heart Attack
2 November 1999 | Volume 131 Issue 9 | Page 648
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Early -Blocker Therapy for Acute Myocardial Infarction in Elderly Patients." It is in the 2 November 1999 issue of Annals of Internal Medicine (volume 131, pages 648-654). The authors are H.M. Krumholz, M.J. Radford, Y. Wang, J. Chen, and T.A. Marciniak.
What is the problem and what is known about it so far?
Beta-blockers, a type of medicine that slows the heart rate, improve how well people do after a coronary heart attack. The earlier that heart attack patients get ß-blockers, the better they seem to do. Ideally, doctors should prescribe these medicines as soon after the heart attack as possible, but this may not be happening as often as it should.
Why did the researchers do this particular study?
The researchers wanted to find out three things: 1) How often did patients older than 65 years of age actually get early ß-blocker therapy during hospitalization for a heart attack? 2) What factors were linked to early use of ß-blockers? 3) Were patients who got early ß-blocker therapy after a heart attack less likely to die during the hospital stay than patients who didn't get these drugs?
Who was studied?
58,165 persons who were 65 years old or older, had Medicare insurance, were hospitalized with a heart attack during 1994 or 1995, and had no reason why they should not get a ß-blocker written in their charts. These patients were in 4414 hospitals across the United States.
How was the study done?
The researchers examined each patient's hospital chart to collect information about the patient, his or her medical condition, any reasons why the patient should not have gotten ß-blockers, whether and when the patient got ß-blockers, and whether the patient died during the hospital stay. They then compared the patients who did get ß-blockers with those who did not.
What did the researchers find?
Just under half of the patients got ß-blockers during hospitalization. Patients who were older, female, or nonwhite were the least likely to get these medicines. Patients who got ß-blockers were also more likely to get other types of therapy, such as aspirin, known to improve heart attack outcomes. Patients who got ß-blockers were more likely to live long enough to leave the hospital after the heart attack than those who did not get these drugs. The benefit of ß-blockers remained even after the researchers accounted for other factors that might have affected how well the patients did.
What were the limitations of the study?
The researchers depended on the hospital charts for all of the information on patients. Possibly, some of the patients had good reasons for not getting ß-blockers, but their doctors and nurses just did not write down the reasons in the charts. Also, the results might not be the same for people with heart attacks who are younger than 65 years of age, or for patients who do not have Medicare insurance.
What are the implications of the study?
Many older heart attack patients who could have received ß-blockers during hospitalization for heart attacks did not get them. This presents a problem because patients who get this medicine are more likely to live long enough to leave the hospital than are patients who don't receive this treatment.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  M Johri, L J Damschroder, B J Zikmund-Fisher, S Y H Kim, and P A Ubel Can a moral reasoning exercise improve response quality to surveys of healthcare priorities? J. Med. Ethics, January 1, 2009; 35(1): 57 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. M. Krumholz, E. H. Bradley, B. K. Nallamothu, H. H. Ting, W. B. Batchelor, E. Kline-Rogers, A. F. Stern, J. R. Byrd, and J. E. Brush Jr A Campaign to Improve the Timeliness of Primary Percutaneous Coronary Intervention: Door-to-Balloon: An Alliance for Quality J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 97 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. M. Krumholz Guideline Recommendations and Results: The Importance of the Linkage Ann Intern Med, September 4, 2007; 147(5): 342 - 343. [Full Text] [PDF]
|
|
|
|
 |
|
 K. P. Alexander, L. K. Newby, P. W. Armstrong, C. P. Cannon, W. B. Gibler, M. W. Rich, F. Van de Werf, H. D. White, W. D. Weaver, M. D. Naylor, et al. Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology Circulation, May 15, 2007; 115(19): 2570 - 2589. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. B. Keller and L. Lemberg Secondary prevention of coronary artery disease in elderly persons: a treatise on a report by the american heart association. Am. J. Crit. Care., September 1, 2006; 15(5): 514 - 518. [Full Text] [PDF]
|
|
|
|
 |
|
 M Weiner, T E Stump, C M Callahan, J N Lewis, and C J McDonald Pursuing integration of performance measures into electronic medical records: beta-adrenergic receptor antagonist medications Qual. Saf. Health Care, April 1, 2005; 14(2): 99 - 106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Stukel, F. L. Lucas, and D. E. Wennberg Long-term Outcomes of Regional Variations in Intensity of Invasive vs Medical Management of Medicare Patients With Acute Myocardial Infarction JAMA, March 16, 2005; 293(11): 1329 - 1337. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. A. Scott, C. P. Denaro, A. C. Hickey, C. Bennett, A. M. Mudge, D. C. Sanders, J. Thiele, and J. L. Flores Optimising care of acute coronary syndromes in three Australian hospitals Int. J. Qual. Health Care, August 1, 2004; 16(4): 275 - 284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Lindenauer, J. Fitzgerald, N. Hoople, and E. M. Benjamin The Potential Preventability of Postoperative Myocardial Infarction: Underuse of Perioperative {beta}-Adrenergic Blockade Arch Intern Med, April 12, 2004; 164(7): 762 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Auerbach and J. Kleinbart Update in Hospital Medicine Ann Intern Med, March 2, 2004; 140(5): 363 - 369. [Full Text] [PDF]
|
|
|
|
|
|
H. Silvet, F. Spencer, J. Yarzebski, D. Lessard, J. M. Gore, and R. J. Goldberg Communitywide Trends in the Use and Outcomes Associated With {beta}-Blockers in Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study Arch Intern Med, October 13, 2003; 163(18): 2175 - 2183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Burwen, D. H. Galusha, J. M. Lewis, M. R. Bedinger, M. J. Radford, H. M. Krumholz, and J. M. Foody National and State Trends in Quality of Care for Acute Myocardial Infarction Between 1994-1995 and 1998-1999: The Medicare Health Care Quality Improvement Program Arch Intern Med, June 23, 2003; 163(12): 1430 - 1439. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Salpeter, T. M. Ormiston, and E. E. Salpeter Cardioselective {beta}-Blockers in Patients with Reactive Airway Disease: A Meta-Analysis Ann Intern Med, November 5, 2002; 137(9): 715 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gheorghiade and S. Goldstein {beta}-Blockers in the Post-Myocardial Infarction Patient Circulation, July 23, 2002; 106(4): 394 - 398. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Williams, J. L. Fleg, P. A. Ades, B. R. Chaitman, N. H. Miller, S. M. Mohiuddin, I. S. Ockene, C. B. Taylor, and N. K. Wenger Secondary Prevention of Coronary Heart Disease in the Elderly (With Emphasis on Patients >=75 Years of Age): An American Heart Association Scientific Statement From the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention Circulation, April 9, 2002; 105(14): 1735 - 1743. [Full Text] [PDF]
|
|
|
|
|
|
A. D. Auerbach and L. Goldman {beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Scientific Review JAMA, March 20, 2002; 287(11): 1435 - 1444. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Auerbach and L. Goldman {beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Clinical Applications JAMA, March 20, 2002; 287(11): 1445 - 1447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Soumerai, T. J. McLaughlin, D. Ross-Degnan, C. L. Christiansen, and J. H. Gurwitz Effectiveness of Thrombolytic Therapy for Acute Myocardial Infarction in the Elderly: Cause for Concern in the Old-Old Arch Intern Med, March 11, 2002; 162(5): 561 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schmidt, P. K. Lindenauer, J. L. Fitzgerald, and E. M. Benjamin Forecasting the Impact of a Clinical Practice Guideline for Perioperative {beta}-Blockers to Reduce Cardiovascular Morbidity and Mortality Arch Intern Med, January 14, 2002; 162(1): 63 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Stroke, April 1, 2000; 31(4): 1002 - 1012. [Full Text] [PDF]
|
|
|
|
|
|
Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Circulation, March 28, 2000; 101(12): 1483 - 1493. [Full Text] [PDF]
|
|
|
|
 |
|
 Beta-Blockers Are Underused for Acute MI Journal Watch Cardiology, December 17, 1999; 1999(1217): 3 - 3. [Full Text]
|
|
|
|
 |
|
 Beta-Blockers Underused for Elderly with MI Journal Watch (General), November 26, 1999; 1999(1126): 1 - 1. [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
