Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction.
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Adrenergic beta-Antagonists; Age Distribution; Aged; Aged, 80 and over; Canada; Cohort Studies; Comorbidity; Dose-Response Relationship, Drug; Humans; Myocardial Infarction; Odds Ratio; Proportional Hazards Models; Recurrence; Risk; Sex Distribution; Survival Rate
Health Services Research | Medicine and Health Sciences
BACKGROUND: Many older people do not receive beta-blocker therapy after myocardial infarction or receive doses lower than those tested in trials, perhaps because physicians fear that beta-blockers may precipitate heart failure. We examined the relation between use of beta-blockers, the dose used, and hospital admission for heart failure and 1-year survival in a cohort of all older patients surviving myocardial infarction in Ontario, Canada. METHODS: We collected data on a cohort of 13,623 patients aged 66 years or older who were discharged from hospital after a myocardial infarction and who did not receive beta-blocker therapy or received low, standard, or high doses. We used Cox's proportional-hazards models to study the association of dose with admission for heart failure and survival with adjustment for factors including age, sex, and comorbidity. FINDINGS: Among 8232 patients with no previous history of heart failure, dispensing of beta-blocker therapy was associated with a 43% reduction in subsequent admission for heart failure (adjusted risk ratio 0.57 [95% CI 0.48-0.69]) compared with patients not dispensed this therapy. Among the 4681 patients prescribed beta-blockers, the risk of admission was greater in the high-dose than in the low-dose group (1.53 [1.01-2.31]). Among all 13,623 patients in the cohort, 2326 (17.1%) died by 1 year. Compared with those not dispensed beta-blocker therapy, the adjusted risk ratio for mortality was lower for all three doses (low 0.40 [0.34-0.47], standard 0.36 [0.31-0.42], high 0.43 [0.33-0.56]). INTERPRETATION: Compared with high-dose beta-blocker therapy, low-dose treatment is associated with a lower rate of hospital admission for heart failure and has a similar 1-year survival benefit. Our findings support the need for a randomised controlled trial comparing doses of beta-blocker therapy in elderly patients.
Lancet. 2000 Aug 19;356(9230):639-44.
Rochon, Paula A.; Tu, Jack V.; Anderson, Geoffrey M.; Gurwitz, Jerry H.; Clark, Jocalyn P.; Lau, Paula; Szalai, John Paul; Sykora, Kathy; and Naylor, C. David, "Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction." (2000). Meyers Primary Care Institute Publications and Presentations. 88.