Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Rhode Island.
J Gerontol A Biol Sci Med Sci. 2019 Jul 12;74(8):1277-1281. doi: 10.1093/gerona/gly191.
We evaluated the burden of adverse events caused by β-blocker use after acute myocardial infarction (AMI) in frail, older nursing home (NH) residents.
This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population was individuals aged ≥65 years who resided in a U.S. NH for ≥30 days, had a hospitalized AMI between May 2007 and March 2010, and returned to the NH. Exposure was new use of β-blockers versus nonuse post-AMI. Orthostasis, general hypotension, falls, dizziness, syncope, and breathlessness outcomes were measured over 90 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using multinomial logistic regression models after 1:1 propensity score-matching of β-blocker users to nonusers.
Among the 10,992 NH propensity score-matched residents with an AMI, the mean age was 84 years and 70.9% were female. β-blocker users were more likely than nonusers to be hospitalized for hypotension (OR = 1.20, 95% CI 1.03-1.39) or experience breathlessness (OR = 1.10, 95% CI 1.01-1.20) after AMI. With the exception of falls, other outcome estimates, though imprecise, were compatible with a potential elevated risk of orthostasis (OR = 1.14, 95% CI 0.96-1.35), syncope, (OR = 1.24, 95% CI 0.55-2.77), and dizziness (OR = 1.28, 95% CI 0.82-1.99) among β-blocker users.
Considered alongside prior evidence that β-blockers may worsen functional outcomes in NH residents with poor baseline functional and cognitive status, our results suggest that providers should exercise caution when prescribing for these vulnerable groups, balancing the mortality benefit against the potential for causing adverse events.
我们评估了β受体阻滞剂在衰弱的老年疗养院（NH）居民中的急性心肌梗死（AMI）后使用引起的不良事件负担。
这是一项回顾性队列研究，使用国家医疗保险索赔与最低数据集评估相关联。研究人群为年龄≥65 岁的个体，他们在 NH 居住≥30 天，在 2007 年 5 月至 2010 年 3 月期间患有住院 AMI，并返回 NH。暴露是 AMI 后新使用β受体阻滞剂与非使用。在 90 天的随访期间，测量了体位性低血压、一般低血压、跌倒、头晕、晕厥和呼吸困难的结果。在 1：1 倾向评分匹配β受体阻滞剂使用者和非使用者后，使用多项逻辑回归模型估计结果的比值比（OR）和 95%置信区间（CI）。
在 10992 名 AMI 匹配的 NH 倾向评分居民中，平均年龄为 84 岁，70.9%为女性。与非使用者相比，β受体阻滞剂使用者更有可能因低血压（OR=1.20，95%CI 1.03-1.39）或呼吸困难（OR=1.10，95%CI 1.01-1.20）而住院。除了跌倒之外，其他结果估计虽然不精确，但与体位性低血压（OR=1.14，95%CI 0.96-1.35）、晕厥（OR=1.24，95%CI 0.55-2.77）和头晕（OR=1.28，95%CI 0.82-1.99）的风险升高可能相关。
考虑到先前的证据表明β受体阻滞剂可能会使基线功能和认知状态较差的 NH 居民的功能结果恶化，我们的结果表明，在为这些弱势群体开处方时，医务人员应谨慎行事，权衡死亡率获益与引起不良事件的潜在风险。
