Viskin S, Kitzis I, Lev E, Zak Z, Heller K, Villa Y, Zajarias A, Laniado S, Belhassen B
Department of Cardiology, Sourasky-Tel Aviv Medical Center, Israel.
J Am Coll Cardiol. 1995 May;25(6):1327-32. doi: 10.1016/0735-1097(94)00552-2.
Our aim was to determine the percent of patients with myocardial infarction who are treated with beta-adrenergic blocking agents in dosages proved to be effective in preventing death after a heart attack.
In the prospective randomized trials showing that beta-blocker treatment improves survival rates after myocardial infarction, relatively high dosages of these agents were used. However, it is not known whether these dosages are used in current clinical practice.
In a retrospective analysis of clinical data from 606 consecutive survivors of myocardial infarction at four university hospitals in three countries, we assessed the number of infarct survivors receiving prospectively defined "effective dosages" of beta-blockers. We defined these dosages as those that demonstrated improved survival rates of infarct survivors who received active drug in large, prospective, double-blind, placebo-controlled trials.
Only 58% of infarct survivors with no contraindications to beta-blockers received these drugs at the time of hospital discharge, and only 11% received dosages equivalent to > 50% of the effective dosages. Independent predictors of failure to prescribe beta-blockers to infarct survivors without contraindications to these drugs were the use of diuretic agents, transient heart failure, impaired left ventricular function and increased patient age. Among patients receiving beta-blockers, only the use of propranolol predicted prescription of a low beta-blocker dosage.
Failure to prescribe beta-blockers after myocardial infarction is common but in most cases is not due to clear contraindications. Many patients not receiving beta-blockers belong to subgroups that would derive the greatest benefit from such treatment. Finally, even when beta-blockers are prescribed, the dosages used are considerably lower than those proved to be effective in preventing death after myocardial infarction.
我们的目的是确定心肌梗死患者中接受β-肾上腺素能阻滞剂治疗的比例，这些患者所使用的药物剂量已被证明对预防心脏病发作后的死亡有效。
在前瞻性随机试验中显示β受体阻滞剂治疗可提高心肌梗死后的生存率，这些药物使用的是相对高剂量。然而，目前尚不清楚这些剂量是否在当前临床实践中使用。
在对三个国家四家大学医院连续606例心肌梗死幸存者的临床资料进行回顾性分析中，我们评估了接受前瞻性定义的“有效剂量”β受体阻滞剂的梗死幸存者人数。我们将这些剂量定义为在大型前瞻性双盲安慰剂对照试验中接受活性药物治疗的梗死幸存者生存率提高的剂量。
在出院时，只有58%无β受体阻滞剂禁忌证的梗死幸存者接受了这些药物治疗，只有11%接受了相当于有效剂量50%以上的剂量。对无β受体阻滞剂禁忌证的梗死幸存者未开具β受体阻滞剂的独立预测因素是使用利尿剂、短暂性心力衰竭、左心室功能受损和患者年龄增加。在接受β受体阻滞剂治疗的患者中，只有使用普萘洛尔预示着β受体阻滞剂剂量较低。
心肌梗死后未开具β受体阻滞剂的情况很常见，但在大多数情况下并非由于明确的禁忌证。许多未接受β受体阻滞剂治疗的患者属于从这种治疗中获益最大的亚组。最后，即使开具了β受体阻滞剂，所使用的剂量也远低于已证明对预防心肌梗死后死亡有效的剂量。
