Abstract
BackgroundLong term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a β-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. This retrospective observational study aimed to investigate the causes for discharge without a β-blocker and relate it to outcome, compared to patients discharged with a β-blocker.MethodsMI-patients registered in Riks-HIA discharged without β-blocker during 2011–2015 (no-β-group) and a control group (β-group) comprised of patients discharged with β-blocker treatment between January 1 to December 31, 2013, were matched by RIKS-HIA criteria for β-blocker use. Clinical characteristics, date of death, readmission for MI, other cardiovascular events were collected from Riks-HIA and medical records.ResultsThe no-β-group included 141 patients, where 65.2% had a justified reason for non-β-blocker use. The β-group included 206 patients. There was no difference in cardiovascular risk factor profile. There were a trend towards a higher number of readmissions for MI in the no-β-group was (n = 8 (5.7%) vs n = 2 (1.0%), p = 0.02), but not mortality (6 (4.3%) vs 2 (1.0%), p = 0.07) and combined readmission for angina pectoris, heart failure, arrhythmias or stroke/TIA (n = 23 (16.3%) vs n = 25 (12.1%), p = 0.27).ConclusionA majority of the patients in the no-β-group had a justified absence of a β-blocker. β-blocker treatment post-MI showed a trend towards fewer readmissions for MI. But important quality information is lacking to make a firm conclusion of the effect on outcome.
Highlights
Long term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA
Data from Riks-HIA showed that of 1631 MI patients discharged from the coronary care unit (CCU) at Helsingborg hospital during the study period 1st of January 2011 to 1st of January 2015, 1155 patients met the criteria for β-blocker treatment
When studying the correlation between lack of a βblocker prescription and clinical outcome, our study showed that the patient group discharged without a βblocker after MI had a significantly higher rate of readmissions for MI during 1 year after index event, compared with the patient group that was discharged with a βblocker
Summary
Long term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a β-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. According to current (2015) guidelines from European Society of Cardiology (ESC) for ST-Elevation Myocardial Infarction (STEMI) patients, long-term treatment with β-blockers is recommended to all patients without contraindications. This is a class II, level of evidence B recommendation, since contemporary RCTs are lacking [9]. According to American guidelines, continuation of treatment with β-blocker for 3 years is strongly recommended (Class I) for STEMI patients with normal left ventricular function. Regarding non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the ESC guidelines recommends long-term β-blocker treatment in patients with an ejection fraction of < 40% [11]
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