Heart attack patients who take recommended beta-blockers are less likely to die or have another heart attack than patients who do not take them. A new study of five community hospitals in Michigan shows that more heart attack patients may be receiving these lifesaving drugs. The study, which was supported in part by the Agency for Healthcare Research and Quality (HS10531), found that beta-blocker use for heart attack patients at these hospitals improved dramatically between 1994 and 1995. However, 13 percent of patients given beta-blockers while in the hospital were not prescribed them at discharge. Also, nonelderly patients were twice as likely as elderly patients to receive a beta-blocker prescription when they were discharged from the hospital.
More effort is needed to improve the use of beta-blockers in heart attack patients after hospital discharge, particularly in elderly patients, according to researchers participating in the Michigan State University Inter-Institutional Collaborative Health (MICH) Study. They examined changes in the rate of beta-blocker use among heart attack patients at admission, in the hospital, and at discharge between 1994 and 1995 (MICH I, 287 patients) and 1997 (MICH II, 121 patients) at the five hospitals. In 1994 and 1995, physicians underprescribed beta-blockers for heart attack patients who had no contraindication (such as congestive heart failure or pulmonary edema) to their use.
Use improved by 23.5 percent in 1997 for patients with a previous history of heart attack on arrival at the hospital (36 vs. 12.5 percent), 29 percent for those in the hospital (76 vs. 47 percent), and 28 percent at discharge (62 vs. 34 percent). Neither race nor sex predicted beta-blocker use. This increase in prescription of beta-blockers most likely resulted from many quality improvements made between the study periods, most notably clinician feedback, as well as 1996 guidelines recommending increased beta-blocker use.
See "Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction," by Adesuwa B. Olomu, M.D., Ralph E. Watson, M.D., Azfar-e-Alam Siddiqi, M.D., and others, in the October 2004 Journal of General Internal Medicine 19, pp. 999-1004.
Editor's Note: Another AHRQ-supported study on a related topic shows that mailing treatment recommendations to primary care doctors caring for newly discharged patients with heart attack or heart failure did not improve their quality of care.
For more details, see Guadagnoli, E., Normand, S-L., DiSalvo, T.G., and others (2004, September). "Effects of treatment recommendations and specialist intervention on care provided by primary care physicians to patients with myocardial infarction or heart failure." (AHRQ grant HS09487). American Journal of Medicine 117, pp. 371-379.
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