National assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)–Retrospective AMI Study

Abstract

Background Since 2007, clinical practice guidelines have recommended beta-blocker therapy early in the course of acute myocardial infarction (AMI) for patients who are not at high risk for complications. Our objective was to perform a national quality assessment of early beta-blocker use during hospitalization for AMI over the past decade in China. Methods We conducted medical record review of a nationally representative sample of patients admitted to Chinese hospitals with AMI and studied those without absolute contraindications to beta-blocker therapy during 2001, 2006, and 2011. We evaluated the use, type, and dose of beta-blockers within the first 24 hours of admission over time and identified predictors of not using this treatment both in ideal candidates and in those with risk factors for cardiogenic shock. Results Among 14,241 patients with AMI (representing 43,165 patients in 2001, 106,167 patients in 2006, and 221,874 patients in 2011 in China, respectively), 45.1% had no contraindications to early beta-blocker therapy; 21.1% had risk factors for cardiogenic shock but no absolute contraindication. Beta-blocker use in ideal patients was 54.3% in 2001, 67.8% in 2006, and 61.8% in 2011 (P=0.28 for trend). Predictors of non-treatment were older age, lower systolic blood pressure, lower heart rate, absence of chest discomfort and admission to a non-teaching hospital. Use in patients with risk factors for cardiogenic shock was 42.6% in 2001, 59.5% in 2006, and 52.9% in 2011 (P=0.31 for trend). Metoprolol was used most frequently (91.5%), but dosages were often below those recommended in guidelines. Conclusions The use of early beta-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed. Patterns of use have not changed over time, thus creating an important target of efforts to improve quality of care for AMI.

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“…Beta-blocker therapy has been recommended in the course of MI for patients who are not at high risk for complications. It has revealed that metoprolol is the most frequently used beta-blocker in MI patients in China [ 23 ]. Daily CHD counts were stratified by gender and age groups (41–65 years, and >65 years).…”

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“…However, the dosing of β-blockers such as Met in the clinic varied markedly, often falling short of guideline recommendations. A national assessment of early β-blocker therapy in patients with AMI in China’s PEACE study reported substantial underuse of early β-blocker therapy in ideal candidates with AMI from 2001 to 201135. A study published in 2021 also reported that the early use of oral β-blockers in acute coronary syndrome patients was generally insufficient, with huge differences among different hospitals in China36.…”

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“…[14] However, due to lack of a specific clinical pathway as a guide, the specific usage of metoprolol still was a practical challenge for clinicians, since the use of beta-blockers was not standardized in terms of dosage and titration method. [31][32][33] The lack of recognition and acceptance of the specific MSDP may result in different practice patterns in different institutions, often fostering potential sub-optimal HR management with clinicians' conservative betablocker titration. The reasonable dosage of metoprolol in ACS patients has been controversial in different reports.…”