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β-Blockade in Older Patients With Myocardial Infarction

Daniel E. Forman, MD; Jeanne Y. Wei, MD
JAMA. 1991;266(16):2222. doi:10.1001/jama.1991.03470160054021.
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To the Editor.  — Despite the consistent demonstration of benefit produced by β-blockade in the peri-infarct period,1,2 a benefit that may be enhanced in the aged,3 many clinicians seem to avoid this class of medications when treating older patients. To test the hypothesis that β-blockers may be underused in older cardiac patients, we conducted a retrospective study to determine whether use of β-blockers in the elderly is decreased out of proportion to the prevalence of contraindications.We studied all patients 50 years and older who were hospitalized sometime between 1984 and 1990 at Beth Israel Hospital, Boston, Mass, for acute myocardial infarction. Of 4387 patients, 831 (19%) were prescribed propranolol hydrochloride, atenolol, timolol, or metoprolol therapy, at a decreasing rate with advancing age (Table). Prevalence of congestive heart failure, chronic obstructive pulmonary disease, or delirium increased with age: 30% among those aged 50 to 59 years, 42% among


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