Beta Blockers Shown To Be Underused, Reducing Survival After Heart Attack

Media Advisory Date: January 7, 1997

Elderly patients who receive beta blockers following a heart attack are 43 percent less likely to die in the first 2 years following the attack than patients who do not receive this drug, according to a new study funded by the Agency for Health Care Policy and Research (AHCPR), published in the January 8 issue of The Journal of the American Medical Association (JAMA).

The study found that patients who receive beta blockers are rehospitalized for heart ailments 22 percent less often than those who do not get beta blockers. However, only 21 percent of eligible patients receive beta blocker therapy.

The researchers examined hospital discharge, drug use and mortality data for 5,332 Medicare beneficiaries in New Jersey who were 30-day survivors of an acute myocardial infarction (AMI). These patients all had prescription drug coverage; of these, 3,737 were eligible for beta blocker therapy.

Researchers found that these patients were almost three times as likely to receive a new prescription for a calcium channel blocker than for a beta blocker after their AMI. Eligible patients receiving calcium channel blockers instead of beta blockers doubled their risk of death.

Advanced age (over age 75), heart failure, and use of calcium channel blockers were likely to mean that the patient would not receive beta blocker therapy. The researchers concluded that underuse of beta blockers in this population leads to an increased rate of hospitalization and mortality. The study is the first to demonstrate the survival benefits of long-term beta blocker treatment in patients over age 75, a group that has been excluded from the clinical trials.

The National Committee for Quality Assurance (NCQA) used the findings of this study as the basis for changing the performance measurement for beta blocker use after AMI to include patients over 75 years of age in the most recent version of the Health Plan Employer Data and Information Set (HEDIS 3.0). NCQA is expanding HEDIS, its managed care survey tool, to include the Medicare population. HEDIS is being used by the Health Care Financing Administration (HCFA) to assess the quality provided by Medicare HMOs. HCFA asked NCQA to include the measure after preliminary results of the study were presented last spring.

The study, entitled "Adverse Outcomes of Underuse of Beta Blockers in Elderly Survivors of Acute Myocardial Infarction," conducted by Stephen B. Soumerai, Sc.D. of Harvard Medical School and Harvard Pilgrim Health Care and colleagues, is a component of AHCPR's Pharmaceutical Outcomes Research Program.

To arrange an interview with Dr. Stephen Soumerai, please contact Patti Embry-Tautenhan at Harvard Pilgrim Health Care, (617) 731-7413.

For additional information, contact AHCPR Public Affairs: Karen Carp, (301) 427-1858; Karen Migdail, (301) 427-1855 ; Salina Prasad, (301) 427-1864.