Current Use of Beta Blockers in Patients With Reactive Airway Disease Who Are Hospitalized With Acute Coronary Syndromes

Olenchock, Benjamin A.; Fonarow, Gregg; Pan, Wenqin; Hernandez, Adrian F.; Cannon, Christopher P.

doi:10.1016/j.amjcard.2008.09.081

Cited by 63 publications

(36 citation statements)

References 17 publications

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“…The current study demonstrates low use of β-blocker therapy in ACS patients with COPD, which is consistent with previous studies, 32,[37][38][39] despite the fact that the use of highly selective β-blockers has been shown to be useful and effective in the majority of COPD. Chen et al 40 examined the relationship between after-discharge use of β-blockers and 1-year mortality in patients with COPD, using data from the Cooperative Cardiovascular Project.…”

Section: Discussionsupporting

confidence: 78%

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Hadi

Zubaid²,

Mahmeed

et al. 2010

Clinical Cardiology

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Background: The purpose of this study was to report the prevalence and the significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute coronary syndrome (ACS). Hypothesis: COPD in patients with ACS is associated with worse outcome. Methods: Data were derived from a prospective, multicenter, multinationalstudy of 8167 consecutive patients hospitalized with ACS from February to June 2007 in 6 Middle Eastern countries. Data were analyzed according to the presence or absence of COPD. Demographic, management, and in-hospital outcomes were compared. Results: The prevalence of COPD was 5.3%. When compared with non-COPD patients, COPD patients were older and more likely to have diabetes, hypertension, and dyslipidemia. Atypical presentations were more common in COPD patients (P = 0.001). COPD patients were less likely to be treated with thrombolytic therapy (P = 0.001), β-blockers (P = 0.001), and glycoprotein IIb/IIIa inhibitors, and more likely to receive angiotensin-converting enzyme (ACE) inhibitors. Although there was no difference in in-hospital mortality between the 2 groups, patients with COPD were more likely to have heart failure (P = 0.001). Despite the fact that COPD patients with ST-segment elevation myocardial infarction were less likely to receive thrombolytic therapy, they suffered more bleeding complications (2.8% vs 1%, P = 0.04), resulting in prolonged hospitalization. COPD was not an independent predictor of increased in-hospital mortality. Conclusions: In this large cohort of patients with ACS, the prevalence of COPD was 5·3%. Atypical presentation is common among COPD patients, and this may result in delayed therapy. ACS in COPD patients was associated with higher risk of heart failure and major bleeding complications without increased risk of in-hospital mortality.

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Section: Discussionsupporting

confidence: 78%

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Hadi

Zubaid²,

Mahmeed

et al. 2010

Clinical Cardiology

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“…2,7 The fact that patients with in-hospital LVEF assessment were more likely to receive these therapies again supports the notion that LVEF assessment may be a marker of in-hospital quality of care. In contrast to a prior study that found patients with LVEF <40% were more likely to be discharged on a β-blocker (26% increase in likelihood) after AMI compared with those with LVEF >40%, 23 our analysis did not find significant differences in β-blocker use between patients with and without demonstrated systolic dysfunction. However, similar to a previous study, a significantly lower rate of cardiac rehabilitation referral was observed for NSTEMI patients with LVEF<40%.…”

Section: Discussioncontrasting

confidence: 56%

Left Ventricular Ejection Fraction Assessment Among Patients With Acute Myocardial Infarction and Its Association With Hospital Quality of Care and Evidence-Based Therapy Use

Miller

Dib

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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Background-The left ventricular ejection fraction (LVEF) has prognostic and therapeutic utility after acute myocardial infarction (AMI). Although LVEF assessment is a key performance measure among AMI patients, contemporary rates of in-hospital assessment and its association with therapy use have not been well characterized. Methods and Results-We examined rates of in-hospital LVEF assessment among 77 982 non-ST-elevation myocardial infarction patients and 50 863 ST-elevation myocardial infarction patients in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between January 2007 and September 2009, after excluding patients who died in-hospital or who were transferred to another acute care facility, discharged to end-of-life care, or had missing LVEF assessment status. LVEF assessment increased significantly over time, with higher rates among STelevation myocardial infarction than non-ST-elevation myocardial infarction patients (95.1% versus 91.6%; P<0.001).Excluding patients with prior heart failure did not alter these observations. Significant interhospital variability in LVEF assessment rates was observed. Compared with patients with in-hospital LVEF assessment, patients who did not have LVEF assessed were older and more likely to have clinical comorbidities. In multivariable modeling, lower overall hospital quality of AMI care was also associated with lower likelihood of LVEF assessment (odds ratio for failure to assess LVEF, 1.09; 95% confidence interval, 1.05-1.13 per 10% decrease in defect-free care). Patients with in-hospital LVEF assessment were more likely to be discharged on evidence-based secondary prevention medication therapies compared with patients without LVEF assessment. Conclusions-The assessment of LVEF among patients with AMI has improved significantly over time, yet significant interhospital variability exists. Patients who did not have in-hospital LVEF assessment were less likely to receive evidence-based medications at discharge. These patients represent targets for future quality improvement efforts. (Circ Cardiovasc Qual Outcomes. 2012;5:662-671.)

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“…Similar results have been seen with other secondary prevention medications for ACS in GWTG-CAD patients. 23 However, in our study, the use of ACEI/ARB seems to be lower than that of other evidence-based therapies, such as aspirin and β-blockers. Thus, ongoing quality improvement initiatives are still necessary to help ensure appropriate secondary prevention is delivered.…”

Section: Benefits Of Acei/arb Therapycontrasting

confidence: 39%

Use of Renin–Angiotensin System Blockers in Acute Coronary Syndromes

Bainey

Armstrong

Fonarow

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background— Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) initiated after myocardial infarction (MI) reduce mortality and are American College of Cardiology/American Heart Association guideline recommended. Yet the extent to which ACEI/ARB therapy is applied in patients with acute coronary syndrome at hospital discharge is unclear. Methods and Results— We performed an observational analysis of 80 241 patients admitted with an acute coronary syndrome and discharged home from 311 US hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program from January 2005 to December 2009. Among the 60 847 patients with an American College of Cardiology/American Heart Association class I indication (left ventricular dysfunction or medical history of heart failure, hypertension, diabetes mellitus, or chronic kidney disease), 49 682 (81.7%) received ACEI/ARB with an increase in the rate of treatment over the study period (76.7%–84.6%; adjusted odds ratio, 1.17; 95% confidence interval, 1.10–1.24; P <0.001, per calendar year). In-hospital coronary artery bypass grafting and renal insufficiency were independently associated with lower use (adjusted odds ratio, 0.55; 95% confidence interval, 0.48–0.63 and adjusted odds ratio, 0.58; 95% confidence interval, 0.52–0.64, respectively). Conclusions— Results from this large US national registry suggest that 1 in 5 eligible patients hospitalized for acute coronary syndrome failed to receive American College of Cardiology/American Heart Association class I guideline-recommended ACEI/ARB therapy, and the use varies by patient factors. In particular, the low likelihood of ACEI/ARB after coronary artery bypass grafting surgery or in patients with renal insufficiency raises concern. These findings highlight an unmet need in this population and provide an incentive for additional quality improvement efforts.

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Current Use of Beta Blockers in Patients With Reactive Airway Disease Who Are Hospitalized With Acute Coronary Syndromes

Cited by 63 publications

References 17 publications

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

Left Ventricular Ejection Fraction Assessment Among Patients With Acute Myocardial Infarction and Its Association With Hospital Quality of Care and Evidence-Based Therapy Use

Use of Renin–Angiotensin System Blockers in Acute Coronary Syndromes

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