Document Detail


beta-Blocker use following myocardial infarction: low prevalence of evidence-based dosing.
MedLine Citation:
PMID:  20826250     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Quality improvement programs have shown increased use of beta-blockers post-myocardial infarction (MI), but there are no data on whether appropriate doses are administered.
METHODS: In a prospective registry that enrolled consecutive patients with MI, we evaluated beta-blocker dosing at discharge after MI and 3 weeks later and assessed clinical predictors for treatment with very low doses. We studied 1,971 patients (70.8% male) with a mean age of 63.9 +/- 13.7 years, of whom 48.2% had an ST-elevation MI.
RESULTS: beta-Blocker utilization rates following MI were 93.2% at discharge: 20.1% received <25% of target dose, 36.5% received 25% of target dose, 26.4% received 26% to 50% of target dose, and 17.0% received >50% of target dose. Between discharge and 3 weeks, 76.4% had no change in beta-blocker dose, with 11.9% and 11.6% having their dose reduced and increased, respectively. Absence of hypertension, acute percutaneous coronary intervention, older age, and no angiotensin-converting enzyme inhibitor therapy were consistent predictors of treatment with very low beta-blocker doses.
CONCLUSIONS: Underdosing of beta-blockers is highly prevalent among patients post-MI. This represents an important opportunity in quality improvement for the care of patients who have suffered an MI.
Authors:
Jeffrey J Goldberger; Robert O Bonow; Michael Cuffe; Alan Dyer; Yves Rosenberg; Robert O'Rourke; Prediman K Shah; Sidney C Smith;
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-09     Completed Date:  2010-11-02     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  435-442.e1     Citation Subset:  AIM; IM    
Copyright Information:
2010 Mosby, Inc. All rights reserved.
Affiliation:
Northwestern University, Chicago, IL 60611, USA. j-goldberger@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage*
Adult
Aged
Aged, 80 and over
Drug Utilization
Evidence-Based Medicine
Female
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy*
Physician's Practice Patterns
Quality Assurance, Health Care
Grant Support
ID/Acronym/Agency:
U01 HL080416-02/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Investigator
Investigator/Affiliation:
P Desai / ; M Betzen / ; J Whitehill / ; L Janak / ; M Lytle / ; M Samendinger / ; E Johnson / ; C Allbritton / ; T Bacon-Howard / ; J Sparks / ; G Nair / ; T Strickland / ; D Lustgarten / ; B Alemy / ; S Forsell / ; L Chadwick / ; M Rowen / ; D Dan / ; K Picardi / ; C Schuger / ; J Dzidowski / ; L Louzon / ; J Messenger / ; B Easley / ; J Morrison / ; F Kusumoto / ; B Little / ; D Mehta / ; E Pe / ; A Simon / ; D Fintel / ; E Karpf / ; D Bello / ; S Harrison / ; S Sawyer / ; I Viera-Fleetwood / ; J Simonson / ; S Barnes / ; J LeTexier / ; M Romanelli / ; L Froehlich / ; S Teller / ; E Herzog / ; R Knox / ; W Warnica / ; D Eichman / ; D Scarcelli / ; B Smith / ; J Mounsey / ; C Blyth / ; C Schuler / ; R Germany / ; J Hubbart / ; M Panday / ; S Harris / ; A Warner / ; J Johnson / ; R Bonow / ; M Cuffe / ; A Dyer / ; J Goldberger / ; R O'Rourke / ; P Shah / ; Y Rosenberg / ; S Smith / ; R Byington / ; M Domanski / ; Z Feng / ; S Goldberg / ; S Goldstein / ; J Kirkpatrick / ; C Love / ; S Singh / ; J Goldberger / ; C Ball / ; J Cahill / ; A Schaechter / ; D Lizcano / ; T Plant / ; A Rosenfeld / ; J Simon / ; A Kadish / ; K Ma / ; H Subacius /
Comments/Corrections

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