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The prevalence of use of beta- blockers in secondary prevention of myocardial infarctions in patients hospitalized 1 Institute of Epidemiology and biostatistics,

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Presentation on theme: "The prevalence of use of beta- blockers in secondary prevention of myocardial infarctions in patients hospitalized 1 Institute of Epidemiology and biostatistics,"— Presentation transcript:

1 The prevalence of use of beta- blockers in secondary prevention of myocardial infarctions in patients hospitalized 1 Institute of Epidemiology and biostatistics, Faculty of Medicine, University of Sarajevo, BiH 2 Clinic for heart disease and rheumatism, Sarajevo

2 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 %.

3 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. (2) 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)

4 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 Controlled- Release/Extended-ReleaseRandomized Intervention Trial in Heart Failure (reduction of all causes by 34%, 40-50% of sudden cardiac death). (4)

5 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.

6 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) Sept [cited 2007 Sept 20]; Volume 357: [about 3p.] Available from: ( )http://content.nejm.org/cgi/content/full/357/12/1175

7 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.

8 Materials and metodes Medical records of hospitalized patients hospitalized in Clinic of cardiovascular diseases KCUS in the period 01.January- 3.June 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).

9 Prevalence of patients with AMI 01. January-30.June Cardivascular Clinic and rheumatism KCUS

10 Mortality of patients with AMI in hospital (01.January- 30.June 2005)

11 The prevalence of patients with AMI in relation to gender The mean age of 196 patients was 62.5 (SD±11,6) years

12 Prevalence of patients with AMI in relation to age group and gender 45.9% over 65 + years,

13 Prevalence of patients with AMI relation gender and age <65 and 65+ Statistically significant higher representation of women over the age of 65 + years ( Hi 2 15,97; p<0,05).

14 Prevalence of risk factors in patients with AMI

15 Prevalence of the application beta-blockers, along with other standard treatment* for patients with AMI

16 Prevalence of the application beta-blockers within seven days after MI, along with other standard treatment* for patients with AMI

17 Prevalence of beta-blockers (atenolol, metoprolol, carvedilol)

18 Prevalence of the application beta-blockers, relation to age group In relation to the age group of patients beta-blockers were significantly less applied in patients over 65 + years ( Hi 2 13,669; p<0,05).

19 Prevalence of the application beta-blockers, relation to left ventricular ejection fraction (LVEF) No statistically significant differences in the use of beta blockers were found (EF 50 in 63.2%; Hi , p<0.05).

20 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.

21 References: 1. Vermeer, N. S., Bajorek, B. V. Utilization of evidence-based therapy for the secondary prevention of acute coronary syndromes in Australian practice. J Clin Pharm Ther. (serial on the Inernet); 2008 Dec, Vol. 33 Issue 6, p , about 11p. Available from: ( )http://www.ncbi.nlm.nih.gov/pubmed/ Lee T. H. Eulogy for a Quality Measure. N Engl J Med(serial on the Inernet) Sept [cited 2007 Sept 20]; Volume 357: [about 3p.] Available from: ( )http://content.nejm.org/cgi/content/full/357/12/ Choudhry, N. K., Avorn, J., Antman, E. M., Schneeweiss, S., Shrank, W. H. Should Patients Receive Secondary Prevention Medications For Free After A Myocardial Infarction? An Economic Analysis. [Health Affairs 26, no. 1 (2007) (serial on the Inernet): ; /hlthaff ] Available from: a0-69f bb5e-f2279e6ce33e%40sessionmgr14 ( ) Choudhry, N. K. a0-69f bb5e-f2279e6ce33e%40sessionmgr14 4. Ellison K.E., Gandhi G. Optimising the use of beta-adrenoceptor antagonists in coronary artery disease. PubMed, 2005;65(6): Available from: ( ) Ellison K.EGandhi G

22 5. OTTERSTAD J. E. Guidelines and registries: Secondary prophylaxis after AMI with emphasis on the use of beta-blockers and ACE inhibitors. Scandinavian Cardiovascular Journal (serial on the Inernet); Feb2005, Vol. 39 Issue 1/2, p10-12, 3p. Available from: 439d f33-82ce-8eb7dbf47ff6%40sessionmgr4 ( ) 439d f33-82ce-8eb7dbf47ff6%40sessionmgr4 6. Lenfant C. Clinical Research to Clinical Practice Lost in Translation? N Engl J Med(serial on the Inernet) Aug[cited 2003 Aug 28]; Volume 349: [about 7p.] Available from: ( ) 7. Dargie H.J7. Dargie H.J. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. (serial on the internet); 2001 Oct 27;358(9291): Available from: ( ) Lancet. (serial on the internet); 2001 Oct 27;358(9291): Gottlieb S. S., McCarter R.J.,Vogel R. A. Effect of Beta-Blockade on Mortality among High-Risk and Low-Risk Patients after Myocardial Infarction. N Engl J Med(serial on the Inernet) Aug [cited 1998 Aug 20]; Volume 339: [about 10p.] Available from: ( )

23 Thank you!!!


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