Abstract
Background:Cardiovascular disease remains the most common cause of death in industrialized countries. The use of beta-blockers is well established as a secondary prevention of myocardial infarction. However, little is known about the benefits of beta-blockers for people living with dementia.Objective:To evaluate the use of beta-blockers in people with dementia who have had a myocardial infarction, in order to identify associations between medication use, mortality, re-infarction and functional decline.Methods:We searched for all studies (randomized trials, observational cohorts) reporting beta-blocker use in populations with both dementia and previous myocardial infarction. Relevant keywords were used in Medline, Embase, and Web of Science up to October 2018. Titles and abstracts were independently screened by two reviewers. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. PRISMA recommendations were followed throughout.Results:Two observational studies were included, representing 10,992 individuals in a community setting and 129,092 individuals from a hospital record-linkage study. One showed use of beta-blockers reduced all-cause mortality (HR 0.74 (95% CI 0.64– 0.86) alongside evidence for an increased rate of functional decline in individuals aged≥65 with moderate to severe cognitive impairment (OR 1.34 (95% CI 1.11– 1.61)). The second study did not find an association between beta-blocker use and mortality in the population living with dementia.Conclusion:There is insufficient evidence to support use of beta-blockers to persons living with dementia. A single study provides limited evidence that beta-blockers improve survival rates but with associated detrimental effects on functional status in nursing home residents with cognitive impairment. Decisions to continue beta-blockers in persons living with dementia should be made on an individual basis.
Highlights
Cardiovascular disease remains the most common cause of death in industrialized countries [1]
Beta-blockers are well-established for pharmacological secondary prevention [2], and have been found to reduce mortality when used in post myocardial infarction (MI) in the general population [3, 4]
The first study investigated dementia status in relation to outcomes in Medicare beneficiaries admitted to hospital with an acute MI between 1994-1995 (Medicare study)
Summary
Cardiovascular disease remains the most common cause of death in industrialized countries [1]. The evidence for the use of beta-blockers is predominantly drawn from clinical trials excluding persons living with dementia [5]. This is despite the fact that cardiovascular disease and dementia commonly co-exist. Methods: We searched for all studies (randomized trials, observational cohorts) reporting beta-blocker use in populations with both dementia and previous myocardial infarction. One showed use of beta-blockers reduced all-cause mortality (HR 0.74 (95%CI 0.64–0.86) alongside evidence for an increased rate of functional decline in individuals aged ≥65 with moderate to severe cognitive impairment (OR 1.34 (95%CI 1.11–1.61)). The second study did not find an association between beta-blocker use and mortality in the population living with dementia. Decisions to continue beta-blockers in persons living with dementia should be made on an individual basis
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