Transcript E. Ademović,1 S. Čavaljuga,1 L. Ibrahimović,1 D.Čelik1, V

The prevalence of use of betablockers in secondary prevention
of myocardial infarctions in
patients hospitalized
ADEMOVIĆ ENISA, ČAVALJUGA SEMRA, IBRAHIMOVIĆ LEJLA, ČELIK
DAMIR1, GERC VJEKOSLAV2
1Institute
of Epidemiology and biostatistics, Faculty of Medicine, University of
Sarajevo, BiH
2Clinic
for heart disease and rheumatism, Sarajevo
 Use of beta-blockers, if for no
contraindications, within seven days after
myocardial infarction and the continuous
application of a period of several months to
three years has shown in many randomized
clinical trials the reduction of total mortality,
reinfarction, sudden cardiac death for 20-30
%.
Historical overview of the major clinical trials
with beta-blockers
 1982 The Beta-Blocker Heart Attack Trial
(BHAT).
(propranolol significantly reduced overall
mortality by 26% compared with placebo.
1984 edition of Braunwald's Heart
Disease
The mid-1990, the percentage of patients
receiving beta-blockers after myocardial
infarction was still just 34% in one major
study and 38% in another.
(2)
(2)
 1996 American College of Cardiology and the
American Heart Association -first
recommendations the use of beta -blockers
in the absence of contraindications for
management of acute myocardial infarction.
(4)
 MERIT-HF (Metoprolol ControlledRelease/Extended-ReleaseRandomized
Intervention Trial in Heart Failure (reduction
of all causes by 34%, 40-50% of sudden
cardiac death).
(4)
 CAPRICORN (Carvedilol Post Infarkt
Survival Control in LV Dysfunction) reduction
in mortality of all causes of death by 23%,
8% lower hospitalization of all diseases, 14%
less hospitalization for cardiovascular
diseases.
 The 2001 American Heart Associatin and
American College of Cardiology (AHA / ACC)
emphasize the importance of application of
beta blockers and give the main guidelines
for the treatment of myocardial infarction.
Use of Beta-Blocker Treatment after Myocardial Infarction,
1996–2005. U.S.
Data are from the National Committee for Quality Assurance.
Source: Lee T. H. Eulogy for a Quality Measure. N Engl J Med(serial on the Inernet). 2007 Sept [cited 2007 Sept 20]; Volume
357:1175-1177 [about 3p.] Available from: http://content.nejm.org/cgi/content/full/357/12/1175 (10.04.2010.)
 The aim of this study was to review medical
records of hospitalized patients with acute
myocardial infarction (AMI) to determine the
prevalenc of use beta-blockers in the
treatment of secondary prevention of
myocardial infarction in relation to patient
age, left ventricular ejection fraction and day
of inclusion in the therapy.
Materials and metodes
 Medical records of hospitalized patients
hospitalized in Clinic of cardiovascular
diseases KCUS in the period 01.January3.June 2005.
 In cross-sectional study included patients
with ST and non-ST AMI.
 Data were collected from the patients history,
echocardiographic findings of heart and
temperature charts with emphasis on the use
of beta-blockers (atenolol, metoprolol, and
carvedilol).
Prevalence of patients with AMI 01. January-30.June
2005. Cardivascular Clinic and rheumatism KCUS
19.73%
80.26%
AMI
Other heart diseases
Mortality of patients with AMI in hospital (01.January30.June 2005)
12.88%
Deaths
No deaths
87.11%
The prevalence of patients with AMI in relation to gender
36.22%
63.77%
The mean age of 196 patients was
62.5 (SD±11,6) years
Men
Women
Prevalence of patients with AMI in relation to age group
and gender
Percentage of patienta mith AIM
40
36,7%
30
22,4%
23,5%
20
Man
Women
11,2%
10
4,6%
1,5%
0
<45
45-65
Age
45.9% over 65 + years,
>65
Prevalence of patients with AMI relation gender and age <65
and 65+
Percenage of patients with AMI
45
40.81
40
35
30
25
21.94
23.97
Men
Women
20
15
13.26
10
5
0
<65
65+
Age group
Statistically significant higher representation of women over the age of
65 + years ( Hi215,97; p<0,05).
Prevalence of risk factors in patients with AMI
60
54,0%
Percenage of patients with AMI (%)
53,6%
49,6,0%
50
40
32,6%
34,4%
30
20
8,0%
10
0
Smoking
Hypertension Dyslipidemia
Diabetes
Family history
Previous
myocardial
infarction
Prevalence of the application beta-blockers, along with
other standard treatment* for patients with AMI
17.85%
82.14%
Beta-blockers +
Beta-blockers-
Prevalence of the application beta-blockers within seven
days after MI, along with other standard treatment* for
patients with AMI
36.20%
63.80%
Beta-blockers +
Beta-blockers-
Prevalence of beta-blockers (atenolol, metoprolol, carvedilol)
Percenage of patients with AMI (%)
70
59,2%
60
50
40
36,0%
30
20
10
4,8%
0
atenolol
metoprolol
carvedilol
Prevalence of the application beta-blockers, relation to
age group
Percentage of patients with AMI (%)
80
75,5%
70
60
50,0% 50,0%
50
Beta-blockers +
Beta-blockers -
40
30
24,5%
20
10
0
<65
65+
In relation to the age group of patients beta-blockers were
significantly less applied in patients over 65 + years ( Hi213,669;
p<0,05).
Prevalence of the application beta-blockers, relation to
left ventricular ejection fraction (LVEF)
Percentage of patients with AMI(%)
80
70
64,3%
68,4%
63,2%
60
50
40
35,7%
36,8%
31,6%
30
Beta-blockers +
Beta-blockers-
20
10
0
<35%
35-50%
>50%
No statistically significant differences in the use of beta blockers were found
(EF <35% in 64.3%, EF 35-50% in 68.4% and EF >50 in 63.2%; Hi2 0.539,
p<0.05).
Conclusion
 Beta-blockers within seven days after AMI
were applied in 63.8% of patients, no
significant differences in the application in
relation to the left ventricular ejection fraction
(EF), but with significantly lower use in
elderly patients 65 + years.
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 Thank you!!!