Communitywide trends in the use and outcomes associated with β-blockers in patients with acute myocardial infarction: The Worcester heart attack study

Abstract

Background: Despite the benefits associated with β-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 β-blockers. This study examines more than 2 decades of trends in the use of β-blockers in hospitalized patients with AMI. Methods: Communitywide study of 10374 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 β-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 β-blockers. After controlling for other prognostic factors, patients treated with β-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 β-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 β-blockers in hospitalized patients with AMI and document the benefits to be gained from this treatment.