Beta blocker use in acute myocardial infarction in West Virginia

This article describes our study of the use of beta blocker drugs in Medicare beneficiaries hospitalized for acute myocardial infarction in West Virginia between 1999 and 2000. We contrasted findings with the responses of practicing cardiologists in the state. The survey asked cardiologists to describe their recent patterns of beta blocker usage, to comment on the severity of generally recognized contraindications to beta blocker administration, and to speculate on reasons why West Virginia's rates of beta blocker use in AMI were lower than rates in most other states. Our study revealed that beta blocker use in AMI declined significantly with patient age, and that rates of use in larger hospitals exceeded those in smaller hospitals. There was little difference attributable to the specialty of the admitting physician. We also observed a positive association between the use of beta blockers in AMI and other appropriate interventions, such as the use of aspirin and revascularization. Cardiologists said they were using more beta blockers in AMI than five years ago, and speculated that high rates of chronic obstructive pulmonary disease and non-specialist physicians were responsible for low rates in West Virginia.