Impact of clinical trials on the use of beta blockers after acute myocardial infarction and its relation to other risk indicators for death and 1-year mortality rate.

Based on selected patient populations, several randomized trials have shown beta blockers to decrease mortality after acute myocardial infarction (AMI). The purpose of this study was to describe the use of beta blockers in various subsets of patients admitted to Sahlgren's Hospital between February 15, 1986, and November 9, 1987, with AMI, and the relation of AMI to other risk indicators for death and to a 1-year mortality rate. Beta blockers, mainly metoprolol, were prescribed for 66% of all survivors at discharge. They were more frequently prescribed for younger patients and for those with a previous history of AMI and hypertension, but less frequently for those with a history of congestive heart failure and diabetes mellitus. Patients for whom beta blockers were not prescribed haa a 1-year mortality of 27% versus 11% for the rest (p < 0.001). Independent predictors of 1-year mortality after discharge were age (p < 0.001), history of hypertension (p < 0.001), prescription of beta blockers at discharge (p < 0.001), congestive heart failure during hospitalization (p < 0.001), and a history of AMI (p < 0.01). P values were corrected for baseline differences. Beta blockers were not prescribed at discharge for one-third of survivors after AMI. This group had a very high mortality during the first year. When simultaneously considering various risk indicators for death, prescription of beta blockers at discharge was associated with an increased rate of survival.