Effects of β-Blockers and Anxiety on Complication Rates After Acute Myocardial Infarction

2011 ◽  
Vol 20 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Mohannad E. Abu Ruz ◽  
Terry A. Lennie ◽  
Debra K. Moser
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Length Of Stay ◽  
Brief Symptom Inventory ◽  
Anxiety Score ◽  
Complication Rates ◽  
Main Effect ◽  
Daily Dose ◽  
Β Blocker ◽  
Β Blockers

Background Anxiety is common after acute myocardial infarction and increases the number of complications and the length of stay in the hospital. Anxiety-induced activation of the sympathetic nervous system is hypothesized to be an underlying cause of increased complication rates. Little is known about whether use of β-blockers eliminates the effects of anxiety on complication rate and length of stay. Objective To compare number of complications and length of stay among nonanxious and anxious patients receiving β-blockers during hospitalization. Method A total of 322 patients with acute myocardial infarction participated in this study within 48 hours of hospital admission. Patients completed the Brief Symptom Inventory to assess anxiety level. After discharge, medical records were reviewed to determine use of β-blockers, type and number of complications, and length of stay. Results Most patients (96%) were treated with less than 200 mg daily of metoprolol. Anxious patients had more complications (mean [SD], 1.43 [0.15] vs 0.73 [.09], P = .01) and longer stays (7.0 [0.49] vs 5.7 [0.36] days, P < .05) than did nonanxious patients. To test whether the dose of β-blocker made a difference, the interaction between daily dose and anxiety score was tested. No interaction was found between metoprolol dose and anxiety score, and no main effect was found for metoprolol dose. Conclusion Anxious patients had more complications and longer stays than did nonanxious patients. The administration of metoprolol did not eliminate this relationship, perhaps because patients did not receive a sufficient dose of metoprolol to counter the effect of anxiety.

In Current Clinical Practice, after Percutaneous Coronary Intervention for Acute Myocardial Infarction, Are β-Blockers Prescribed for Heart Failure or as Secondary Prevention? A Pilot Study

Cardiology ◽  
2018 ◽  
Vol 140 (3) ◽  
pp. 152-154 ◽  
Author(s):  
Vidar Ruddox ◽  
Jan Erik Otterstad ◽  
Dan Atar ◽  
Bjørn Bendz ◽  
Thor Edvardsen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Pilot Study ◽  
Secondary Prevention ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Β Blocker ◽  
Β Blockers

Objectives: Patients surviving an acute myocardial infarction (AMI) are different today than when oral β-blockers first were shown to have an incremental effect on mortality. They are now, as opposed to then, offered revascularization procedures and effective secondary prevention. In this pilot-study, we aimed to explore the prescription of β-blockers to these patients stratified by their left ventricular ejection fraction (LVEF). Methods: Consecutive stable patients treated with a percutaneous coronary intervention (PCI) procedure following an AMI were included for measurement of LVEF after 1–5 days. β-Blocker treatment was recorded at inclusion and after 3 months. Results: We included 159 patients, 89% with LVEF ≥40% (56% had a LVEF ≥50% [preserved], 33% LVEF 40–49% [mid-range] and 11% LVEF <40% [reduced]). At discharge the prescription rates of β-blockers according to LVEF stratification were 79% for preserved, 79% for mid-range and 94% for reduced LVEF. After 3 months 72% of all patients continued such treatment. Conclusions: In this prospective study, a large proportion of contemporary managed patients with AMI but without clinical heart failure does not have reduced LVEF shortly after PCI, but the majority is still treated with a β-blocker.

scholarly journals Comprehensive Comparative Effectiveness and Safety of First-Line β-Blocker Monotherapy in Hypertensive Patients

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1528-1538
Author(s):  
Seng Chan You ◽  
Harlan M. Krumholz ◽  
Marc A. Suchard ◽  
Martijn J. Schuemie ◽  
George Hripcsak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Comparative Effectiveness ◽  
Third Generation ◽  
First Line ◽  
The Third ◽  
Empirical Calibration ◽  
Β Blocker ◽  
Β Blockers

Evidence for the effectiveness and safety of the third-generation β-blockers other than atenolol in hypertension remains scarce. We assessed the effectiveness and safety of β-blockers as first-line treatment for hypertension using 3 databases in the United States: 2 administrative claims databases and 1 electronic health record–based database from 2001 to 2018. In each database, comparative effectiveness of β-blockers for the risks of acute myocardial infarction, stroke, and hospitalization for heart failure was assessed, using large-scale propensity adjustment and empirical calibration. Estimates were combined across databases using random-effects meta-analyses. Overall, 118 133 and 267 891 patients initiated third-generation β-blockers (carvedilol and nebivolol) or atenolol, respectively. The pooled hazard ratios (HRs) of acute myocardial infarction, stroke, hospitalization for heart failure, and most metabolic complications were not different between the third-generation β-blockers versus atenolol after propensity score matching and empirical calibration (HR, 1.07 [95% CI, 0.74–1.55] for acute myocardial infarction; HR, 1.06 [95% CI, 0.87–1.31] for stroke; HR, 1.46 [95% CI, 0.99–2.24] for hospitalized heart failure). Third-generation β-blockers were associated with significantly higher risk of stroke than ACE (angiotensin-converting enzyme) inhibitors (HR, 1.29 [95% CI, 1.03–1.72]) and thiazide diuretics (HR, 1.56 [95% CI, 1.17–2.20]). In conclusion, this study found many patients with first-line β-blocker monotherapy for hypertension and no statistically significant differences in the effectiveness and safety comparing atenolol with third-generation β-blockers. Patients on third-generation β-blockers had a higher risk of stroke than those on ACE inhibitors and thiazide diuretics.

scholarly journals Patient-Important Adverse Events of β-blockers in Frail Older Adults after Acute Myocardial Infarction

2018 ◽  
Vol 74 (8) ◽  
pp. 1277-1281 ◽  
Author(s):  
Andrew R Zullo ◽  
Matthew Olean ◽  
Sarah D Berry ◽  
Yoojin Lee ◽  
Jennifer Tjia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Adverse Events ◽  
Multinomial Logistic Regression ◽  
Cognitive Status ◽  
Vulnerable Groups ◽  
Data Set ◽  
Β Blocker ◽  
Β Blockers

Abstract Background We evaluated the burden of adverse events caused by β-blocker use after acute myocardial infarction (AMI) in frail, older nursing home (NH) residents. Methods This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population was individuals aged ≥65 years who resided in a U.S. NH for ≥30 days, had a hospitalized AMI between May 2007 and March 2010, and returned to the NH. Exposure was new use of β-blockers versus nonuse post-AMI. Orthostasis, general hypotension, falls, dizziness, syncope, and breathlessness outcomes were measured over 90 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using multinomial logistic regression models after 1:1 propensity score-matching of β-blocker users to nonusers. Results Among the 10,992 NH propensity score-matched residents with an AMI, the mean age was 84 years and 70.9% were female. β-blocker users were more likely than nonusers to be hospitalized for hypotension (OR = 1.20, 95% CI 1.03–1.39) or experience breathlessness (OR = 1.10, 95% CI 1.01–1.20) after AMI. With the exception of falls, other outcome estimates, though imprecise, were compatible with a potential elevated risk of orthostasis (OR = 1.14, 95% CI 0.96–1.35), syncope, (OR = 1.24, 95% CI 0.55–2.77), and dizziness (OR = 1.28, 95% CI 0.82–1.99) among β-blocker users. Conclusions Considered alongside prior evidence that β-blockers may worsen functional outcomes in NH residents with poor baseline functional and cognitive status, our results suggest that providers should exercise caution when prescribing for these vulnerable groups, balancing the mortality benefit against the potential for causing adverse events.

β Blockade after acute myocardial infarction

1990 ◽  
Vol 28 (12) ◽  
pp. 47-48
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Fibrinolytic Therapy ◽  
Force Of Contraction ◽  
Care Policy ◽  
Late Mortality ◽  
Β Blocker ◽  
Coronary Care ◽  
Β Blockers

After myocardial infarction β blockers are used to slow the heart, reduce its force of contraction and to lower the blood pressure. Several multicentre studies have shown that using them routinely reduces both early and late mortality. What impact have these findings had on coronary care policy in Britain? Is it still important to prescribe a β blocker now that most patients who have had a myocardial infarction will have had fibrinolytic therapy?

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

scholarly journals National Use and Effectiveness of β-Blockers for the Treatment of Elderly Patients After Acute Myocardial Infarction

JAMA ◽  
1998 ◽  
Vol 280 (7) ◽  
pp. 623 ◽  
Author(s):  
Harlan M. Krumholz ◽  
Martha J. Radford ◽  
Yun Wang ◽  
Jersey Chen ◽  
Asefeh Heiat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Elderly Patients ◽  
Β Blockers

Abstract 14759: Burden of Intracranial Hemorrhage in Patients With Acute Myocardial Infarction in the United States, 2000-2017

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sri Harsha Patlolla ◽  
Saraschandra Vallabhajosyula
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Intracranial Hemorrhage ◽  
Temporal Trends ◽  
The United States ◽  
Circulatory Support ◽  
White Race ◽  
Hospitalization Costs

Introduction: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). Methods: The National Inpatient Sample database (2000 to 2017) was used to evaluate in-hospital burden of ICH in adult (>18 years) AMI admissions. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy (PEG) were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, admissions with ICH were on average older, female, of non-White race, with greater comorbidities, and higher rates of arrhythmias (all p<0.001). Female sex, non-White race, ST-segment-elevation AMI presentation, use of fibrinolytics, mechanical circulatory support and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%) as compared to those without (all p<0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 [95% CI 5.47-5.84]; p<0.001), and adjusted temporal trends showed a steady decrease in in-hospital mortality over the 18-year period (Figure 1A). AMI-ICH admissions also had longer hospital length of stay, higher hospitalization costs, and greater use of PEG (all p<0.001). In AMI-ICH survivors (N=13, 689), 81.3% had a poor functional outcome indicating severe morbidity and temporal trends revealed a slight increase over the study period (Figure 1B). Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality, resource utilization, and poor functional outcomes.

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