Half of elderly patients admitted to hospital with acute myocardial infarction (MI) do not receive early treatment with b-blockers, and those at highest risk are the least likely to receive treatment, say researchers from the US.
Dr Harlan Krumholz (Yale university school of medicine, Connecticut) and colleagues assessed the use and effectiveness of b-blocker therapy in patients aged 65 or over within two days of hospital admission for acute MI.
They investigated the records of 58,165 patients from 4,414 hospitals and found that 51 per cent of patients with no contraindications to beta-blockers had not received b-blockers on the day of admission or the next day. Patients who did not receive b-blocker treatment were more likely to be older and female, and were less likely to be white. Those who received early therapy had significantly lower in-hospital mortality rates than those who did not (5.1 per cent versus 8.1 per cent, respectively) and a 19 per cent odds reduction in rates of in-hospital death.
The authors say that the decision to treat varied with geographical region and age, but that, in a substantial number of cases, the variation in the decision to use b-blockers remained unexplained. They comment that b-blockers are "economically attractive" because they are inexpensive.
"The benefit of early beta-blocker use may be even more important than their use at discharge because patients who do not get these medications early may not survive until discharge," they say.
Dr Krumholz et al conclude that many elderly patients are not receiving the benefit of early beta-blocker treatment, despite evidence of its efficacy and its cost-effectiveness. They exhort doctors to increase their efforts to use early b-blockers in appropriate elderly patients with acute MI. (Annals of Internal Medicine 1999;131:648)