β-Blocker use following myocardial infarction: Low prevalence of evidence-based dosing

Jeffrey Goldberger, Robert O. Bonow, Michael Cuffe, Alan Dyer, Yves Rosenberg, Robert O'Rourke, Prediman K. Shah, Sidney C. Smith

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Quality improvement programs have shown increased use of β-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 β-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: β-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 β-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 β-blocker doses. Conclusions: Underdosing of β-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.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume160
Issue number3
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

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Myocardial Infarction
Quality Improvement
Enzyme Therapy
Quality of Health Care
Percutaneous Coronary Intervention
Angiotensin-Converting Enzyme Inhibitors
Registries
Hypertension
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

β-Blocker use following myocardial infarction : Low prevalence of evidence-based dosing. / Goldberger, Jeffrey; Bonow, Robert O.; Cuffe, Michael; Dyer, Alan; Rosenberg, Yves; O'Rourke, Robert; Shah, Prediman K.; Smith, Sidney C.

In: American Heart Journal, Vol. 160, No. 3, 01.01.2010.

Research output: Contribution to journalArticle

Goldberger, J, Bonow, RO, Cuffe, M, Dyer, A, Rosenberg, Y, O'Rourke, R, Shah, PK & Smith, SC 2010, 'β-Blocker use following myocardial infarction: Low prevalence of evidence-based dosing', American Heart Journal, vol. 160, no. 3. https://doi.org/10.1016/j.ahj.2010.06.023
Goldberger, Jeffrey ; Bonow, Robert O. ; Cuffe, Michael ; Dyer, Alan ; Rosenberg, Yves ; O'Rourke, Robert ; Shah, Prediman K. ; Smith, Sidney C. / β-Blocker use following myocardial infarction : Low prevalence of evidence-based dosing. In: American Heart Journal. 2010 ; Vol. 160, No. 3.
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abstract = "Background: Quality improvement programs have shown increased use of β-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 β-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: β-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 β-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 β-blocker doses. Conclusions: Underdosing of β-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.",
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