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Early β-Blocker Therapy for Acute Myocardial Infarction in Elderly Patients

Harlan M. Krumholz, MD; Martha J. Radford, MD; Yun Wang, MS; Jersey Chen, BA; and Thomas A. Marciniak, MD
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From Yale University School of Medicine and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut; and the Health Care Financing Administration, Baltimore, Maryland.


Grant Support: Dr. Krumholz is a Paul Beeson Faculty Scholar. The analyses on which this report is based were performed under contract 500-96-P549, titled “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, and the mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care and therefore required no special funding on the part of this Contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.

Requests for Reprints: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, New Haven, CT 06520-8025; e-mail, harlan.krumholz@yale.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Krumholz and Mr. Chen: Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, New Haven, CT 06520-8025.

Dr. Radford: Center for Outcomes Research and Evaluation, Yale-New Haven Health System, 20 York Street, GB 415, New Haven, CT 06504.

Mr. Wang: Qualidigm, 100 Roscommon Drive, Middletown, CT 06457.

Dr. Marciniak: Health Care Financing Administration, 7500 Security Boulevard, Building S2-11-07, Baltimore, MD 21244-1850.


Ann Intern Med. 1999;131(9):648-654. doi:10.7326/0003-4819-131-9-199911020-00003
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Therapy with β-blockers is an effective and inexpensive early treatment for acute myocardial infarction. Several trials, including the Metoprolol in Acute Myocardial Infarction (MIAMI) Trial and the First International Study of Infarct Survival (ISIS-1) have reported that β-blocker therapy reduces short-term mortality rates in patients with suspected acute myocardial infarction (15). On the basis of these studies, the Guidelines for the Management of Patients with Acute Myocardial Infarction, published by the American College of Cardiology and the American Heart Association, strongly endorse the early use of β-blocker therapy for patients without a contraindication (6).

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Use of β-blocker therapy in the United States, by state or territory.
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Summary for Patients

Beta-blocker Medicines for Older People after Heart Attack

The summary below is from the full report titled “Early -Blocker Therapy for Acute Myocardial Infarction in Elderly Patients.” It is in the 2 November 1999 issue of Annals of Internal Medicine (volume 131, pages 648-654). The authors are H.M. Krumholz, M.J. Radford, Y. Wang, J. Chen, and T.A. Marciniak.

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