Dataset Information

?-blockers after myocardial infarction and 1-year clinical outcome - a retrospective study.

ABSTRACT: BACKGROUND:Long term ?-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. ?-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a ?-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. This retrospective observational study aimed to investigate the causes for discharge without a ?-blocker and relate it to outcome, compared to patients discharged with a ?-blocker. METHODS:MI-patients registered in Riks-HIA discharged without ?-blocker during 2011-2015 (no-?-group) and a control group (?-group) comprised of patients discharged with ?-blocker treatment between January 1 to December 31, 2013, were matched by RIKS-HIA criteria for ?-blocker use. Clinical characteristics, date of death, readmission for MI, other cardiovascular events were collected from Riks-HIA and medical records. RESULTS:The no-?-group included 141 patients, where 65.2% had a justified reason for non-?-blocker use. The ?-group included 206 patients. There was no difference in cardiovascular risk factor profile. There were a trend towards a higher number of readmissions for MI in the no-?-group was (n?=?8 (5.7%) vs n?=?2 (1.0%), p?=?0.02), but not mortality (6 (4.3%) vs 2 (1.0%), p?=?0.07) and combined readmission for angina pectoris, heart failure, arrhythmias or stroke/TIA (n?=?23 (16.3%) vs n?=?25 (12.1%), p?=?0.27). CONCLUSION:A majority of the patients in the no-?-group had a justified absence of a ?-blocker. ?-blocker treatment post-MI showed a trend towards fewer readmissions for MI. But important quality information is lacking to make a firm conclusion of the effect on outcome.

SUBMITTER: Hagsund T

PROVIDER: S-EPMC7146968 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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β-blockers after myocardial infarction and 1-year clinical outcome - a retrospective study.

Hagsund Tora T Olsson Sven-Erik SE Smith J Gustav JG Madsen Hardig Bjarne B Wagner Henrik H

BMC cardiovascular disorders 20200409 1

<h4>Background</h4>Long term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a β-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. This retrosp ...[more]

PMID: 32272880

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Project description:Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients. Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups. Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727-0.978), and propensity score (HR 0.882; 95% CI 0.724-0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702-0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs. Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

Project description:BackgroundFor acute myocardial infarction (AMI) without heart failure (HF), it is unclear if β-blockers are associated with reduced mortality.ObjectivesThe goal of this study was to determine the association between β-blocker use and mortality in patients with AMI without HF or left ventricular systolic dysfunction (LVSD).MethodsThis cohort study used national English and Welsh registry data from the Myocardial Ischaemia National Audit Project. A total of 179,810 survivors of hospitalization with AMI without HF or LVSD, between January 1, 2007, and June 30, 2013 (final follow-up: December 31, 2013), were assessed. Survival-time inverse probability weighting propensity scores and instrumental variable analyses were used to investigate the association between the use of β-blockers and 1-year mortality.ResultsOf 91,895 patients with ST-segment elevation myocardial infarction and 87,915 patients with non-ST-segment elevation myocardial infarction, 88,542 (96.4%) and 81,933 (93.2%) received β-blockers, respectively. For the entire cohort, with >163,772 person-years of observation, there were 9,373 deaths (5.2%). Unadjusted 1-year mortality was lower for patients who received β-blockers compared with those who did not (4.9% vs. 11.2%; p < 0.001). However, after weighting and adjustment, there was no significant difference in mortality between those with and without β-blocker use (average treatment effect [ATE] coefficient: 0.07; 95% confidence interval [CI]: -0.60 to 0.75; p = 0.827). Findings were similar for ST-segment elevation myocardial infarction (ATE coefficient: 0.30; 95% CI: -0.98 to 1.58; p = 0.637) and non-ST-segment elevation myocardial infarction (ATE coefficient: -0.07; 95% CI: -0.68 to 0.54; p = 0.819).ConclusionsAmong survivors of hospitalization with AMI who did not have HF or LVSD as recorded in the hospital, the use of β-blockers was not associated with a lower risk of death at any time point up to 1 year. (β-Blocker Use and Mortality in Hospital Survivors of Acute Myocardial Infarction Without Heart Failure; NCT02786654).

Dataset Information

?-blockers after myocardial infarction and 1-year clinical outcome - a retrospective study.

Publications

β-blockers after myocardial infarction and 1-year clinical outcome - a retrospective study.

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