Beta-blocker use in acute myocardial infarction patients with congestive heart failure
Background: Beta-blockers have been shown to improve outcomes for patients with acute myocardial infarction (AMI), but have been used reluctantly in AMI patients with congestive heart failure (CHF). However, recent studies have shown that the benefits of beta-blockers outweigh the risks in AMI patients with CHF, and that beta-blockers are a safe and effective treatment for these patients. The purpose of this study is to evaluate the use of beta-blockers in AMI patients with CHF. Methods: A random sample of 4,478 patients aged 65 and older was selected from all fee-for-service Medicare beneficiaries discharged from California hospitals between January to June, 1998 with a principal diagnosis of AMI. After unconfirmed AMI cases and those with unknown discharge status were excluded, there were 2,680 cases for analysis. Results: In this study, 48.2% (1,291) of all AMI patients, and 66.2% (290/438) of those with no contraindications received a beta-blocker. Overall, 40.1% (1,074) had CHF plus other contraindications, and 11.6% (312) had CHF but had no other contraindications. Controlling for age, race, and gender, and compared to those with no contraindications, beta-blocker prescription rates were significantly lower among patients who had CHF as the only documented reason for not prescribing a beta-blocker (OR=0.3, 95% CI=0.3-0.5). Conclusions: Beta-blockers are underutilized in this sample of AMI patients. CHF is an independent predictor for non-prescription of a beta-blocker. Despite evidence from recent studies suggesting its benefit, beta-blocker use is still suboptimal in AMI patients, particularly those with CHF.