Abstract 16235: Impact of Long-term Adherence to β-blocker Therapy on Survival in Statin-treated Patients after AMI: Should Current Practice Guidelines be Revisited?
Background and aim: Trials of beta-blockers in post-AMI patients have been performed at a time when reperfusion therapy or statin treatment were not used. The aim of this study was to assess the prognostic impact of long-term adherence to beta-blocker treatment in AMI pts treated with statins.
Patients and methods: We used the administrative database of hospital stays (PMSI) in pts covered by the general medical coverage insurance to select pts admitted for AMI during the first 6 months of 2006. Data were cross-linked with the outpatients medications reimbursement database (SNIIRAM). Of 7,986 pts alive 6 months after the index episode and on continued statin therapy, 999 (12.5%) were not prescribed beta-blockers and 6,987 initially received beta-blockers; among those, 5460 (78%) had satisfactory adherence to beta-blocker treatment (>80% of expected doses for the whole follow-up period reimbursed). Mortality over 30 months of follow-up was compared between pts adherent to beta-blockers, non adherent pts and never-prescribed pts. We used Cox multivariate analysis to determine the HR for death, with adjustment on age, sex, comorbidities, concomitant medications and procedures used during the index hospital stay.
Results: Crude mortality at 30 months was 11.0% in pts not prescribed beta-blockers, 4.1% in pts prescribed beta-blockers but who were not adherent, and 5.1% in pts adherent to beta-blockers. After Cox multivariate adjustment, the HR for 30-month death was 1.33 (95%CI: 1.04–1.70) for pts not prescribed beta-blockers and 0.83 (95%CI: 0.63–1.10) for pts not adherent to beta-blockers, compared with pts with adequate treatment adherence. Similar results were observed when survival free of recurrent ACS was studied.
Conclusion: In statin-treated pts surviving 6 months after AMI, adherence to beta-blocker therapy was not associated with improved long-term mortality or ACS-free survival. In contrast, pts who were not prescribed beta-blockers initially had a higher mortality. These results suggest that, in pts receiving up-to-date treatment following myocardial infarction, long-term treatment with beta-blockers, past the first 6 months after the acute episode, might be reconsidered.
- © 2010 by American Heart Association, Inc.