Underuse of beta-blockers following myocardial infarction: a tale of two cities.

Abstract:

AIMS:To measure factors associated with underuse of beta-blocker therapy after myocardial infarction (MI). METHODS:The Newcastle and Perth collaborating centres of the World Health Organization (WHO) MONICA project (to MONItor trends and determinants of Cardiovascular disease) systematically evaluated all patients admitted to hospital in their respective regions with possible MI. A total of 1766 patients in Newcastle and 4,503 patients in Perth, discharged from hospital after confirmed MI from 1985 to 1993, were studied. Rates of beta-blocker use before and after hospital discharge were evaluated and correlates of beta-blocker use determined. RESULTS:Beta-blocker use was similar in Newcastle and Perth before MI (21% of patients in each centre). During hospital admission, beta-blocker therapy was initiated nearly twice as frequently in Perth compared with Newcastle (66 vs 36%, respectively) and more patients were discharged from hospital on beta-blockers in Perth (68%) than in Newcastle (45%). The main factors associated with underuse of beta-blockers in multivariate analysis were geographical centre (odds ratio (OR) for Newcastle compared with Perth 0.3; 95% confidence interval (CI) 0.3-0.3), a history of previous MI (OR 0.6, 95% CI 0.5-0.7), admission to hospital in earlier years (OR 0.4, 95% CI 0.3-0.4 for years 1985-87 compared with years 1991-93), diabetes (OR 0.6, 95% CI 0.5-0.8) and the concomitant use of diuretics (OR 0.5, 95% CI 0.4-0.6) and calcium antagonists (OR 0.6, 95% CI 0.5-0.8). CONCLUSIONS:Underuse of beta-blockers after MI was strongly related to hospital prescribing patterns and not to community use of beta-blockers. Underuse occurred in patients with diabetes and in patients with left ventricular dysfunction, patients who stand to benefit most from beta-blocker use following MI.

journal_name

Intern Med J

authors

Nicholls SJ,McElduff P,Dobson AJ,Jamrozik KD,Hobbs MS,Leitch JW

doi

10.1046/j.1445-5994.2001.00098.x

keywords:

subject

Has Abstract

pub_date

2001-09-01 00:00:00

pages

391-6

issue

7

eissn

1444-0903

issn

1445-5994

journal_volume

31

pub_type

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