Abstract
Background: Results of recent studies suggest that β-blockers are underused by elderly acute myocardial infarction (AMI) survivors. The goals of this study were to examine changes in post-AMI β-blocker use occurring between 1994 and 1997 and to identify factors associated with outpatient use of β-blockers. Methods: Patients included 9534 individuals ≥65 years of age who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) and who survived AMI between 1994 and 1997. With the use of outpatient prescription claims, β-blocker usage rates were examined by year, and multivariate logistic regression was used to identify predictors of β-blocker use. Results: Post-AMI β-blocker use increased from 39.6% in 1994 to 58.6% in 1997. Controlling for AMI year, individuals who had any prescriptions written by a cardiologist were more likely to use a β-blocker than individuals who received all prescriptions from noncardiologists (odds ratio 1.52, P = .0001). Elderly patients who did not use β-blockers tended to have greater severity of illness, non-Q-wave infarctions, atrial fibrillation, and comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, and asthma. Use of calcium channel blockers and diuretics was negatively associated with β-blocker use, but persons using lipid-lowering agents were more likely to use β-blockers. Conclusions: Significant improvements in β-blocker use by elderly AMI survivors have occurred since 1994. Differences among physician specialties in β-blocker prescribing appear to remain. Across all prescriber specialties, historic contraindications constitute major factors in the choice of post-AMI therapy. Further efforts should be made to encourage the use of β-blockers in elderly survivors of AMI, particularly those with heart failure.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 663-671 |
| Number of pages | 9 |
| Journal | American Heart Journal |
| Volume | 140 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 1 2000 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Changes in rates of β-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction. / Heller, D. A.; Ahern, F. M.; Kozak, M.
In: American Heart Journal, Vol. 140, No. 4, 01.01.2000, p. 663-671.Research output: Contribution to journal › Article
TY - JOUR
T1 - Changes in rates of β-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction
AU - Heller, D. A.
AU - Ahern, F. M.
AU - Kozak, M.
PY - 2000/1/1
Y1 - 2000/1/1
N2 - Background: Results of recent studies suggest that β-blockers are underused by elderly acute myocardial infarction (AMI) survivors. The goals of this study were to examine changes in post-AMI β-blocker use occurring between 1994 and 1997 and to identify factors associated with outpatient use of β-blockers. Methods: Patients included 9534 individuals ≥65 years of age who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) and who survived AMI between 1994 and 1997. With the use of outpatient prescription claims, β-blocker usage rates were examined by year, and multivariate logistic regression was used to identify predictors of β-blocker use. Results: Post-AMI β-blocker use increased from 39.6% in 1994 to 58.6% in 1997. Controlling for AMI year, individuals who had any prescriptions written by a cardiologist were more likely to use a β-blocker than individuals who received all prescriptions from noncardiologists (odds ratio 1.52, P = .0001). Elderly patients who did not use β-blockers tended to have greater severity of illness, non-Q-wave infarctions, atrial fibrillation, and comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, and asthma. Use of calcium channel blockers and diuretics was negatively associated with β-blocker use, but persons using lipid-lowering agents were more likely to use β-blockers. Conclusions: Significant improvements in β-blocker use by elderly AMI survivors have occurred since 1994. Differences among physician specialties in β-blocker prescribing appear to remain. Across all prescriber specialties, historic contraindications constitute major factors in the choice of post-AMI therapy. Further efforts should be made to encourage the use of β-blockers in elderly survivors of AMI, particularly those with heart failure.
AB - Background: Results of recent studies suggest that β-blockers are underused by elderly acute myocardial infarction (AMI) survivors. The goals of this study were to examine changes in post-AMI β-blocker use occurring between 1994 and 1997 and to identify factors associated with outpatient use of β-blockers. Methods: Patients included 9534 individuals ≥65 years of age who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) and who survived AMI between 1994 and 1997. With the use of outpatient prescription claims, β-blocker usage rates were examined by year, and multivariate logistic regression was used to identify predictors of β-blocker use. Results: Post-AMI β-blocker use increased from 39.6% in 1994 to 58.6% in 1997. Controlling for AMI year, individuals who had any prescriptions written by a cardiologist were more likely to use a β-blocker than individuals who received all prescriptions from noncardiologists (odds ratio 1.52, P = .0001). Elderly patients who did not use β-blockers tended to have greater severity of illness, non-Q-wave infarctions, atrial fibrillation, and comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, and asthma. Use of calcium channel blockers and diuretics was negatively associated with β-blocker use, but persons using lipid-lowering agents were more likely to use β-blockers. Conclusions: Significant improvements in β-blocker use by elderly AMI survivors have occurred since 1994. Differences among physician specialties in β-blocker prescribing appear to remain. Across all prescriber specialties, historic contraindications constitute major factors in the choice of post-AMI therapy. Further efforts should be made to encourage the use of β-blockers in elderly survivors of AMI, particularly those with heart failure.
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UR - http://www.scopus.com/inward/citedby.url?scp=0033820021&partnerID=8YFLogxK
U2 - 10.1067/mhj.2000.109650
DO - 10.1067/mhj.2000.109650
M3 - Article
C2 - 11011343
AN - SCOPUS:0033820021
VL - 140
SP - 663
EP - 671
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 4
ER -