Abstract
Background: Discharge beta blocker (BB) prescription after myocardial infarction (MI) is guideline recommended for all eligible patients and is a core quality measure. Numerous BB choices are presently available that vary with regard to their glycometabolic effects, a potentially important consideration in patients with diabetes mellitus (DM). We studied whether clinicians preferentially select BBs with favorable metabolic effects in patients with DM. Methods: Among 4316 MI patients from 24 US hospitals enrolled in the TRIUMPH registry (2005-08), we investigated the frequency of “DM-friendly” BB use at discharge by DM status. BB were classified as potentially favorable (e.g., carvedilol, labetalol), or potentially adverse (e.g., metoprolol, atenolol) with regards to their effects on glycemic control. Hierarchical logistic regression examined the association of DM with favorable BB use, adjusting for LV dysfunction to examine whether the favorable BB were being selected primarily for their metabolic effects or for their heart failure indication. Results: Mean age was 59, 33% were women, 30% nonwhite, and 31% (n=1331) had DM. BB were prescribed at discharge in 90.4% of patients without DM and in 91.4% of those with DM (Figure). Only a small fraction of DM patients received a favorable BB (13.7%), but this proportion was modestly higher than in patients without DM (10.3%; p=0.001; unadjusted OR for DM vs non-DM 1.52, 95% CI 1.24-1.87). After adjusting for LV dysfunction (which was more common in DM patients and strongly associated with greater use of favorable BB; OR 4.57, 95% CI 3.69-5.65), the association of DM with use of favorable BB was attenuated but remained significant (OR 1.44, 95% CI 1.16-1.78). Discussion: In a large, multicenter MI registry, DM was associated with increased discharge prescription of BBs with potentially favorable effects on glycemic control. However, the vast majority of DM patients were still prescribed BB with potentially adverse metabolic effects. Continued efforts to discern the clinical relevance of the metabolic effects of BBs are needed, and if clinical differences are demonstrated, significant opportunities exist to improve current practices of BB use in diabetic patients.
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