Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Use of beta-blocking agents in secondary prevention after myocardial infarction: a case for evidence-based medicine?
GISSI experience, 1984–1993
Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche ‘Mario Negri’ Milano, Italy
revised 10 March 1997; accepted 13 March 1997.
Correspondence: GISSI Coordinating Center, Via Eritrea 62, 20157 Milano, Italy
Abstract
AIMS: Many clinical trials conducted in the 1970s and early 1980s have shown that the long-term use of beta-blockers after an acute myocardial infarction significantly reduces mortality and reinfarction rates. This study assessed the impact of these findings in clinical practice.
METHODS: We retrospectively analysed the beta-blocker prescriptions for 36 817 patients with acute myocardial infarction included in three large randomized clinical trials (Gruppo Italiano di Studio sulla Sopravvivenza nell'Infarto Miocardico—GISSI, 1, 2 and 3), conducted by a highly representative sample (about 75%) of Italian coronary care units in 1984–85, 1988–89 and 1991–93.
RESULTS: The prescription of beta-blockers at discharge increased gradually from 8·5% in 1984–85 to 25·0% in 1988–89 and to 31·4% in 1991–93. A similar trend was apparent for beta-blocker prescriptions 6 months after acute myocardial infarction. The strongest predictors of beta-blocker prescription are the presence of post-infarctual angina and a history of arterial hypertension. Besides the classical contraindications, advanced age, transitory cardiac failure or arrhythmias in the acute phase of acute myocardial infarction are important predictors of nonprescription.
CONCLUSION: The use of beta-blockers after acute myocardial infarction in Italy has increased more than three-fold in the last decade, but they are still prescribed to too few patients, especially those at higher risk, for whom the expected benefit is greater.
Key Words: Beta-blockers • myocardial infarction • secondary prevention • pharmaco-epidemiology
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