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Communitywide Trends in the Use and Outcomes Associated With -Blockers in Patients With Acute Myocardial Infarction

The Worcester Heart Attack Study

Helme Silvet, MD; Frederick Spencer, MD; Jorge Yarzebski, MD, MPH; Darleen Lessard, MS; Joel M. Gore, MD; Robert J. Goldberg, PhD

Arch Intern Med. 2003;163:2175-2183.

Background  Despite the benefits associated with -blocker therapy in patients with acute myocardial infarction (AMI), limited recent data are available describing the extent of use of this therapy and the associated hospital and long-term outcomes, particularly from the perspective of a population-based study. Data are also limited about the characteristics of patients with AMI who do not receive -blockers. This study examines more than 2 decades of trends in the use of -blockers in hospitalized patients with AMI.

Methods  Communitywide study of 10 374 patients hospitalized with confirmed AMI in all metropolitan Worcester hospitals during 12 annual periods between 1975 and 1999.

Results  There was a marked increase in the use of -blockers in hospitalized patients between 1975 (11%) and 1999 (82%). Older patients, women, and patients with comorbidities were significantly less likely to be treated with -blockers. After controlling for other prognostic factors, patients treated with -blockers were less likely to develop heart failure (adjusted odds ratio [OR], 0.58; 95% confidence interval [CI], 0.53-0.63), cardiogenic shock (OR, 0.46; 95% CI, 0.39-0.54), and primary ventricular fibrillation (OR, 0.84; 95% CI, 0.65-1.08) and were less likely to die (OR, 0.26; 95% CI, 0.22-0.29) during hospitalization than were patients who did not receive this therapy. Patients who used -blockers during hospitalization had significantly lower death rates after hospital discharge.

Conclusions  The results of this observational study demonstrate encouraging trends in the use of -blockers in hospitalized patients with AMI and document the benefits to be gained from this treatment.

From the Department of Medicine, Harvard Medical School, Boston, Mass (Dr Silvett); and the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Spencer, Yarzebski, Gore, and Goldberg and Ms Lessard). The authors have no relevant financial interest in this article.

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