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Calcium channel blockers and mortality in elderly patients with myocardial infarction
J G Jollis1, R J Simpson, M K Chowdhury
1Duke Clinical Research Institute, Duke University, Durham, NC, USA. james.jollis@duke.edu
Insights
Calcium channel blockers are generally safe for elderly patients after myocardial infarction. This study found no increased mortality risk, except for bepridil, supporting further trials for ischemic heart disease treatment.
Area of Science:
- Cardiology
- Pharmacology
- Geriatric Medicine
Background:
- Calcium channel blockers (CCBs) are used for angina, hypertension, and atrial fibrillation.
- Concerns exist regarding CCB safety in patients with coronary artery disease.
Purpose of the Study:
- To investigate the association between CCB use at hospital discharge and mortality in elderly patients with acute myocardial infarction (AMI).
Main Methods:
- Retrospective cohort study utilizing medical charts and administrative data.
- Included 141,041 Medicare patients discharged alive after AMI between 1994-1995.
- Assessed 30-day and 1-year mortality rates.
Main Results:
- CCBs were prescribed to 51,921 elderly AMI patients (diltiazem, nifedipine, amlodipine, verapamil most common).
- No increased 30-day or 1-year mortality risk was found for CCB users after adjusting for confounders.
- An exception was bepridil (n=116), associated with increased mortality due to proarrhythmic effects.
Conclusions:
- No overall mortality risk identified with CCB therapy in elderly AMI patients.
- Findings support the need for prospective trials on CCB use in ischemic heart disease.
- Bepridil should be used cautiously in this population due to identified risks.
Background:
Although calcium channel blockers are a useful therapy in relieving angina, lowering blood pressure, and slowing conduction of atrial fibrillation, growing evidence has cast doubt on their safety in patients with coronary disease.
Objective:
To examine the association between calcium channel blocker therapy at hospital discharge and mortality in a population-based sample of elderly patients hospitalized with acute myocardial infarction.
Design:
Retrospective cohort study using data from medical charts and administrative files.
Setting:
All acute care hospitals in 46 states.
Patients:
All Medicare patients with a principal diagnosis of acute myocardial infarction consecutively discharged from the hospital alive during 8-month periods between 1994 and 1995 (N = 141,041).
Main Outcome Measure:
Mortality at 30 days and 1 year.
Results:
Calcium channel blockers were widely prescribed at hospital discharge to elderly patients with myocardial infarction between 1994 and 1995 (n = 51,921), the most commonly prescribed being diltiazem (n = 21,175), nifedipine (n = 12,670), amlodipine (n = 11,683), and verapamil (n = 3639). After adjusting for illness severity and concomitant medication use, patients who were prescribed calcium channel blockers at hospital discharge did not have increased risk for 30-day or 1-year mortality, with the exception of the few (n = 116) treated with bepridil. Bepridil differs from other calcium channel blockers because of its tendency to prolong repolarization, and its association with proarrhythmic effects in elderly patients.
Conclusion:
We did not identify a mortality risk in a large consecutive sample of elderly patients with myocardial infarction, which supports the need for additional prospective trials examining calcium channel blocker therapy for ischemic heart disease.