Premium
Association Between Functional Status and Use and Effectiveness of Beta‐Blocker Prophylaxis in Elderly Survivors of Acute Myocardial Infarction
Author(s) -
Vitagliano Gail,
Curtis Jeptha P.,
Concato John,
Feinstein Alvan R.,
Radford Martha J.,
Krumholz Harlan M.
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52153.x
Subject(s) - medicine , myocardial infarction , beta blocker , odds ratio , confidence interval , medical prescription , cohort , retrospective cohort study , physical therapy , cohort study , heart failure , pharmacology
Objectives: To examine whether physical and cognitive impairments explain low use of beta‐blockers in elderly patients and whether functionally impaired older adults have improved survival if a beta‐blocker is prescribed at hospital discharge. Design: Cross‐sectional and retrospective cohort study. Setting: Acute care hospitals in the United States. Participants: National cohort of 45,370 elderly acute myocardial infarction survivors, with no chart‐documented contraindications to beta‐blocker treatment. Measurements: The main outcome measures were beta‐blocker prescription at hospital discharge and 1‐year survival. Results: Fifty percent (n=22,683) of eligible patients were prescribed a beta‐blocker at discharge. Older age and functional impairments (incontinence, mobility impairment, and cognitive impairment) were independently associated with decreased use of beta‐blockers. The odds ratios for prescribing a beta‐blocker at hospital discharge were 0.82 (95% confidence interval (CI)=0.77–0.86), 0.63 (95% CI=0.56–0.71), and 0.40 (95% CI=0.32–0.51) for persons with one, two, and three impairments, respectively, compared with those with no impairments. In survival analysis, patients prescribed a beta‐blocker were 21% less likely than nonrecipients to die within 1 year of follow‐up (relative risk=0.79, P= .0001). Similar survival benefit was observed in patients with and without functional impairments. Conclusion: This study shows a strong association between functional impairment and the use of beta‐blockers after acute myocardial infarction in elderly patients. The results suggest that increasing use of beta‐blockers in this group provides an opportunity to improve outcomes.