Utilization of beta blockers post-myocardial infarction

Beta blockers provide both morbidity and mortality benefits for post-myocardial infarction (MI) patients. Despite this, beta blockers are still often underused or used at suboptimal dosages. This was a retrospective observational study with the objectives of estimating the proportion of post-MI patients who are receiving beta-blocker therapy in University Malaya Medical Centre (UMMC), assessing the number of them receiving beta blockers at optimal dosages and determining the factors associated with beta-blocker prescribing post-MI. Of 315 patient case notes reviewed, 77.5% were prescribed beta blockers. However, dosages were optimized in only 39.3% of patients. Reasons for not optimizing the dosages were typically not due to the presence of contraindications to beta blockers. Elderly (> 65 years old), ejection fraction (EF) < 40%, a history of cerebrovascular accident (CVA) or mild asthma, use of calcium channel blocker (CCB), digoxin or anti-asthmatic agents were all significantly associated with a reduced rate of beta-blocker prescribing post-MI. More effort should be placed in improving its use in specific patient populations. Initiatives to optimize the dosage of beta blockers to recommended dosages that matched those in clinical trials with proven mortality benefits will also need to be intensified.
Study site: University Malaya Medical Centre, Kuala Lumpur