Beta-blockers Still Underutilized in the Emergency Department
This viewpoint offers commentary on important clinical research in the area of pharmacy.
Vega DD, Dolan KL, Pollack ML
Am J Emerg Med. 2006;24:435-439
A retrospective chart review of patients presenting to a single emergency department (ED) with ST-elevation acute myocardial infarction (STEMI) was conducted from December 2001 through October 2003. Demographic information and contraindications to beta-blocker use were noted (systolic blood pressure < 100 mm Hg, heart rate < 60 bpm, second- or third-degree heart block, acute asthma, acute exacerbation of chronic obstructive pulmonary disease, or acute congestive heart failure).
A total of 385 patients who met the inclusion criteria were included in the analysis. Most of the patients were male (63%) and 60 years of age or older (71%). In this group, 141 patients (37%) had contraindications to beta-blocker therapy. Of the remaining 244 patients, just over half (53%) did not receive a beta-blocker in the ED. Among patients over 60 years of age, 59% did not receive a beta-blocker, compared with 41% in the younger age bracket. Among females, 51% did not receive a beta-blocker, while 54% of males remained untreated.
The availability of treatment guidelines based on substantial published data is increasing. Despite this availability, many effective therapies are underutilized. In this study, only about half of the patients presenting to the ED with STEMI were treated with beta-blockers, even though no contraindications were evident. This study was a chart review, so additional data might have been available and the statistic different in a prospective study. Data collected during this study indicate that the elderly are not receiving beta-blockers as frequently as younger patients are. Pharmacists practicing in the health-system environment must continue to educate other clinicians on the benefits of and true contraindications to treatments contained within guidelines, and they must persevere to increase the usage of these valuable therapies.
Abstract
This viewpoint offers commentary on important clinical research in the area of pharmacy.
ß-blocker Use In Elderly ED Patients With Acute Myocardial Infarction
Vega DD, Dolan KL, Pollack ML
Am J Emerg Med. 2006;24:435-439
Study Summary
A retrospective chart review of patients presenting to a single emergency department (ED) with ST-elevation acute myocardial infarction (STEMI) was conducted from December 2001 through October 2003. Demographic information and contraindications to beta-blocker use were noted (systolic blood pressure < 100 mm Hg, heart rate < 60 bpm, second- or third-degree heart block, acute asthma, acute exacerbation of chronic obstructive pulmonary disease, or acute congestive heart failure).
A total of 385 patients who met the inclusion criteria were included in the analysis. Most of the patients were male (63%) and 60 years of age or older (71%). In this group, 141 patients (37%) had contraindications to beta-blocker therapy. Of the remaining 244 patients, just over half (53%) did not receive a beta-blocker in the ED. Among patients over 60 years of age, 59% did not receive a beta-blocker, compared with 41% in the younger age bracket. Among females, 51% did not receive a beta-blocker, while 54% of males remained untreated.
Viewpoint
The availability of treatment guidelines based on substantial published data is increasing. Despite this availability, many effective therapies are underutilized. In this study, only about half of the patients presenting to the ED with STEMI were treated with beta-blockers, even though no contraindications were evident. This study was a chart review, so additional data might have been available and the statistic different in a prospective study. Data collected during this study indicate that the elderly are not receiving beta-blockers as frequently as younger patients are. Pharmacists practicing in the health-system environment must continue to educate other clinicians on the benefits of and true contraindications to treatments contained within guidelines, and they must persevere to increase the usage of these valuable therapies.
Abstract