Beta-blocker use in elderly ED patients with acute myocardial infarction
David D Vega1, Kendra L Dolan, Marc L Pollack
1Department of Emergency Medicine, York Hospital, York, PA 17405, USA. dvega@wellspan.org
Insights
Beta-blockers are underused in heart attack patients, particularly the elderly. Age, not gender, significantly impacts beta-blocker administration in emergency departments.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Beta-blockers (BB) are proven to reduce mortality in acute myocardial infarction (AMI).
- BB utilization in the emergency department (ED) for AMI remains suboptimal.
- Elderly patients and women may face higher risks of BB underutilization.
Purpose of the Study:
- To investigate the influence of patient age and gender on BB administration in AMI cases within the ED.
- To identify disparities in BB use based on demographic factors.
Main Methods:
- Retrospective analysis of ST-elevation AMI (STEMI) patients in an ED from 2001-2003.
- Assessment of BB contraindications including hypotension, bradycardia, AV block, bronchospasm, and heart failure.
- Chi-square analysis to compare BB use across different age groups and genders.
Main Results:
- Of 385 STEMI patients, 71% were over 60 and 38% were women.
- 70% of patients did not receive BB; 52% of these had contraindications.
- Among eligible patients, 53% did not receive BB. Elderly patients (over 60) were less likely to receive BB compared to younger patients (P=.011).
Conclusions:
- BB are underutilized in ED AMI management, with a notable deficit in elderly patients.
- No significant gender-based difference in BB use was observed.
- Targeted educational initiatives for emergency physicians on BB use in AMI, especially for elderly patients, are recommended.
Background:
Despite the effectiveness of early beta-blocker (BB) use in reducing mortality in acute myocardial infarction (AMI), they remain underutilized in the emergency department (ED) management of AMI. The elderly, with higher AMI mortality, and women, may be particularly vulnerable to underutilization of BB.
Objective:
To determine the effect of age and gender on BB use in AMI in the ED.
Methods:
A retrospective study of all ST-elevation AMI (STEMI) ED patients presenting to a community hospital ED from 2001 to 2003. Any contraindication to BB use (hypotension, bradycardia, AV block, active bronchospasm, and active congestive heart failure) was determined. Chi-square analysis was used to determine differences by gender and age.
Results:
Three hundred eighty-five patients with STEMI were identified. Thirty-eight percent were women and 71% were over 60 years of age. Of the 270 (70%) who did not receive BB, 141 (52%) had contraindications to BB use. The total BB eligible group was 244 (63%). Of patients without contraindications to BB, 53% did not receive BB in the ED. By gender, 83 (54%) males and 46 (51%) females did not receive BB (P=.669). By age, 96 subjects (59%) over age 60 and 33 subjects (41%) under age 60 did not receive BB (P=.011).
Conclusion:
Despite convincing evidence of effectiveness, BB remain underutilized in ED management of AMI, especially in the elderly. There does not appear to be a gender difference in BB use. Education programs should be directed towards emergency physicians regarding BB use in AMI, especially in elderly ED patients.
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