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    Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction.

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    Authors
    Rochon, Paula A.
    Tu, Jack V.
    Anderson, Geoffrey M.
    Gurwitz, Jerry H.
    Clark, Jocalyn P.
    Lau, Paula
    Szalai, John Paul
    Sykora, Kathy
    Naylor, C. David
    UMass Chan Affiliations
    Department of Medicine, Division of Geriatric Medicine
    Meyers Primary Care Institute
    Document Type
    Journal Article
    Publication Date
    2000-08-19
    Keywords
    Adrenergic beta-Antagonists
    Age Distribution
    Aged
    Aged, 80 and over
    Canada
    Cohort Studies
    Comorbidity
    Dose-Response Relationship, Drug
    Humans
    Myocardial Infarction
    Odds Ratio
    Proportional Hazards Models
    Recurrence
    Risk
    Sex Distribution
    Survival Rate
    Health Services Research
    Medicine and Health Sciences
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    Link to Full Text
    http://dx.doi.org/10.1016/S0140-6736(00)02606-4
    Abstract
    BACKGROUND: Many older people do not receive beta-blocker therapy after myocardial infarction or receive doses lower than those tested in trials, perhaps because physicians fear that beta-blockers may precipitate heart failure. We examined the relation between use of beta-blockers, the dose used, and hospital admission for heart failure and 1-year survival in a cohort of all older patients surviving myocardial infarction in Ontario, Canada. METHODS: We collected data on a cohort of 13,623 patients aged 66 years or older who were discharged from hospital after a myocardial infarction and who did not receive beta-blocker therapy or received low, standard, or high doses. We used Cox's proportional-hazards models to study the association of dose with admission for heart failure and survival with adjustment for factors including age, sex, and comorbidity. FINDINGS: Among 8232 patients with no previous history of heart failure, dispensing of beta-blocker therapy was associated with a 43% reduction in subsequent admission for heart failure (adjusted risk ratio 0.57 [95% CI 0.48-0.69]) compared with patients not dispensed this therapy. Among the 4681 patients prescribed beta-blockers, the risk of admission was greater in the high-dose than in the low-dose group (1.53 [1.01-2.31]). Among all 13,623 patients in the cohort, 2326 (17.1%) died by 1 year. Compared with those not dispensed beta-blocker therapy, the adjusted risk ratio for mortality was lower for all three doses (low 0.40 [0.34-0.47], standard 0.36 [0.31-0.42], high 0.43 [0.33-0.56]). INTERPRETATION: Compared with high-dose beta-blocker therapy, low-dose treatment is associated with a lower rate of hospital admission for heart failure and has a similar 1-year survival benefit. Our findings support the need for a randomised controlled trial comparing doses of beta-blocker therapy in elderly patients.
    Source
    Lancet. 2000 Aug 19;356(9230):639-44.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37332
    PubMed ID
    10968437; 10968437
    Related Resources
    Link to article in PubMed
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    UMass Chan Faculty and Researcher Publications

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