Vitagliano Gail, Curtis Jeptha P, Concato John, Feinstein Alvan R, Radford Martha J, Krumholz Harlan M
Department of Medicine, School of Medicine, Yale University, New Haven, and Clinical Epidemiology Unit, Veterans Affairs Connecticuat Healthcare System, West Haven, Connecticut, USA.
J Am Geriatr Soc. 2004 Apr;52(4):495-501. doi: 10.1111/j.1532-5415.2004.52153.x.
To examine whether physical and cognitive impairments explain low use of beta-blockers in elderly patients and whether functionally impaired older adults have improved survival if a beta-blocker is prescribed at hospital discharge.
Cross-sectional and retrospective cohort study.
Acute care hospitals in the United States.
National cohort of 45,370 elderly acute myocardial infarction survivors, with no chart-documented contraindications to beta-blocker treatment.
The main outcome measures were beta-blocker prescription at hospital discharge and 1-year survival.
Fifty percent (n=22,683) of eligible patients were prescribed a beta-blocker at discharge. Older age and functional impairments (incontinence, mobility impairment, and cognitive impairment) were independently associated with decreased use of beta-blockers. The odds ratios for prescribing a beta-blocker at hospital discharge were 0.82 (95% confidence interval (CI)=0.77-0.86), 0.63 (95% CI=0.56-0.71), and 0.40 (95% CI=0.32-0.51) for persons with one, two, and three impairments, respectively, compared with those with no impairments. In survival analysis, patients prescribed a beta-blocker were 21% less likely than nonrecipients to die within 1 year of follow-up (relative risk=0.79, P=.0001). Similar survival benefit was observed in patients with and without functional impairments.
This study shows a strong association between functional impairment and the use of beta-blockers after acute myocardial infarction in elderly patients. The results suggest that increasing use of beta-blockers in this group provides an opportunity to improve outcomes.
探讨身体和认知功能障碍是否能解释老年患者β受体阻滞剂使用不足的情况，以及功能受损的老年人在出院时开具β受体阻滞剂是否能提高生存率。
横断面和回顾性队列研究。
美国的急性护理医院。
45370名老年急性心肌梗死幸存者的全国队列，病历中无β受体阻滞剂治疗的禁忌证记录。
主要结局指标为出院时β受体阻滞剂的处方情况和1年生存率。
50%（n = 22683）符合条件的患者在出院时开具了β受体阻滞剂。年龄较大和功能障碍（失禁、行动障碍和认知障碍）与β受体阻滞剂使用减少独立相关。与无功能障碍者相比，有1项、2项和3项功能障碍的患者出院时开具β受体阻滞剂的比值比分别为0.82（95%置信区间（CI）= 0.77 - 0.86）、0.63（95% CI = 0.56 - 0.71）和0.40（95% CI = 0.32 - 0.51）。在生存分析中，开具β受体阻滞剂的患者在随访1年内死亡的可能性比未接受者低21%（相对风险 = 0.79，P = 0.0001）。在有和无功能障碍的患者中均观察到类似的生存获益。
本研究表明老年患者急性心肌梗死后功能障碍与β受体阻滞剂的使用之间存在密切关联。结果表明，增加该组患者β受体阻滞剂的使用为改善预后提供了机会。
