Changes in rates of β-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction

D. A. Heller, F. M. Ahern, M. Kozak

Research output: Contribution to journalArticle

31 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)663-671
Number of pages9
JournalAmerican Heart Journal
Volume140
Issue number4
DOIs
StatePublished - Jan 1 2000

Fingerprint

Survivors
Myocardial Infarction
Prescriptions
Outpatients
Heart Failure
Calcium Channel Blockers
Contracts
Diuretics
Atrial Fibrillation
Chronic Obstructive Pulmonary Disease
Infarction
Comorbidity
Asthma
Logistic Models
Odds Ratio
Physicians
Lipids
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{bb97907c1a5a44ff85df01a9e73245f0,
title = "Changes in rates of β-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction",
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.",
author = "Heller, {D. A.} and Ahern, {F. M.} and M. Kozak",
year = "2000",
month = "1",
day = "1",
doi = "10.1067/mhj.2000.109650",
language = "English (US)",
volume = "140",
pages = "663--671",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

}

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 journalArticle

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.

UR - http://www.scopus.com/inward/record.url?scp=0033820021&partnerID=8YFLogxK

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 -