Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Suzanne V. Arnold, John A. Spertus, Kasia J. Lipska, David E. Lanfear, Fengming Tang, Anna Grodzinsky, Darren K McGuire, M. Odette Gore, Abhinav Goyal, Thomas M. Maddox, Mikhail Kosiborod

Research output: Contribution to journalArticle

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Abstract

Background Discharge β-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous β-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive β-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control postdischarge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005-2008), we investigated the frequency of "DM-friendly" β-blocker prescription at discharge by DM status. β-Blockers were classified as DM-friendly (eg, carvedilol and labetalol) or non-DM-friendly (eg, metoprolol and atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly β-blocker use. Among DM patients, we examined the association of DM-friendly β-blockers with worsened glycemic control at 6 months after MI. Results Of 4,031 MI patients, 1,382 (34%) had DM. β-Blockers were prescribed at discharge in 93% of patients. Diabetes mellitus-friendly β-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly β-blocker compared with patients without DM (13.5% vs 10.3%, P =.003), an association that remained after multivariable adjustment (odds ratio 1.41, 95% CI 1.13-1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly versus non-DM-friendly β-blockers (Relative Risk 0.80, 95% CI 0.60-1.08). Conclusion Most DM patients were prescribed non-DM-friendly β-blockers - a practice that was associated with a trend toward worse glycemic control postdischarge. Although in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of β-blockers use in patients with DM.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume168
Issue number3
DOIs
StatePublished - 2014

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Diabetes Mellitus
Myocardial Infarction
Prescriptions
Labetalol
Metoprolol
Atenolol
Registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Arnold, S. V., Spertus, J. A., Lipska, K. J., Lanfear, D. E., Tang, F., Grodzinsky, A., ... Kosiborod, M. (2014). Type of β-blocker use among patients with versus without diabetes after myocardial infarction. American Heart Journal, 168(3). https://doi.org/10.1016/j.ahj.2014.04.018

Type of β-blocker use among patients with versus without diabetes after myocardial infarction. / Arnold, Suzanne V.; Spertus, John A.; Lipska, Kasia J.; Lanfear, David E.; Tang, Fengming; Grodzinsky, Anna; McGuire, Darren K; Gore, M. Odette; Goyal, Abhinav; Maddox, Thomas M.; Kosiborod, Mikhail.

In: American Heart Journal, Vol. 168, No. 3, 2014.

Research output: Contribution to journalArticle

Arnold, SV, Spertus, JA, Lipska, KJ, Lanfear, DE, Tang, F, Grodzinsky, A, McGuire, DK, Gore, MO, Goyal, A, Maddox, TM & Kosiborod, M 2014, 'Type of β-blocker use among patients with versus without diabetes after myocardial infarction', American Heart Journal, vol. 168, no. 3. https://doi.org/10.1016/j.ahj.2014.04.018
Arnold, Suzanne V. ; Spertus, John A. ; Lipska, Kasia J. ; Lanfear, David E. ; Tang, Fengming ; Grodzinsky, Anna ; McGuire, Darren K ; Gore, M. Odette ; Goyal, Abhinav ; Maddox, Thomas M. ; Kosiborod, Mikhail. / Type of β-blocker use among patients with versus without diabetes after myocardial infarction. In: American Heart Journal. 2014 ; Vol. 168, No. 3.
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abstract = "Background Discharge β-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous β-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive β-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control postdischarge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005-2008), we investigated the frequency of {"}DM-friendly{"} β-blocker prescription at discharge by DM status. β-Blockers were classified as DM-friendly (eg, carvedilol and labetalol) or non-DM-friendly (eg, metoprolol and atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly β-blocker use. Among DM patients, we examined the association of DM-friendly β-blockers with worsened glycemic control at 6 months after MI. Results Of 4,031 MI patients, 1,382 (34{\%}) had DM. β-Blockers were prescribed at discharge in 93{\%} of patients. Diabetes mellitus-friendly β-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly β-blocker compared with patients without DM (13.5{\%} vs 10.3{\%}, P =.003), an association that remained after multivariable adjustment (odds ratio 1.41, 95{\%} CI 1.13-1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly versus non-DM-friendly β-blockers (Relative Risk 0.80, 95{\%} CI 0.60-1.08). Conclusion Most DM patients were prescribed non-DM-friendly β-blockers - a practice that was associated with a trend toward worse glycemic control postdischarge. Although in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of β-blockers use in patients with DM.",
author = "Arnold, {Suzanne V.} and Spertus, {John A.} and Lipska, {Kasia J.} and Lanfear, {David E.} and Fengming Tang and Anna Grodzinsky and McGuire, {Darren K} and Gore, {M. Odette} and Abhinav Goyal and Maddox, {Thomas M.} and Mikhail Kosiborod",
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AU - Spertus, John A.

AU - Lipska, Kasia J.

AU - Lanfear, David E.

AU - Tang, Fengming

AU - Grodzinsky, Anna

AU - McGuire, Darren K

AU - Gore, M. Odette

AU - Goyal, Abhinav

AU - Maddox, Thomas M.

AU - Kosiborod, Mikhail

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N2 - Background Discharge β-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous β-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive β-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control postdischarge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005-2008), we investigated the frequency of "DM-friendly" β-blocker prescription at discharge by DM status. β-Blockers were classified as DM-friendly (eg, carvedilol and labetalol) or non-DM-friendly (eg, metoprolol and atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly β-blocker use. Among DM patients, we examined the association of DM-friendly β-blockers with worsened glycemic control at 6 months after MI. Results Of 4,031 MI patients, 1,382 (34%) had DM. β-Blockers were prescribed at discharge in 93% of patients. Diabetes mellitus-friendly β-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly β-blocker compared with patients without DM (13.5% vs 10.3%, P =.003), an association that remained after multivariable adjustment (odds ratio 1.41, 95% CI 1.13-1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly versus non-DM-friendly β-blockers (Relative Risk 0.80, 95% CI 0.60-1.08). Conclusion Most DM patients were prescribed non-DM-friendly β-blockers - a practice that was associated with a trend toward worse glycemic control postdischarge. Although in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of β-blockers use in patients with DM.

AB - Background Discharge β-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous β-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive β-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control postdischarge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005-2008), we investigated the frequency of "DM-friendly" β-blocker prescription at discharge by DM status. β-Blockers were classified as DM-friendly (eg, carvedilol and labetalol) or non-DM-friendly (eg, metoprolol and atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly β-blocker use. Among DM patients, we examined the association of DM-friendly β-blockers with worsened glycemic control at 6 months after MI. Results Of 4,031 MI patients, 1,382 (34%) had DM. β-Blockers were prescribed at discharge in 93% of patients. Diabetes mellitus-friendly β-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly β-blocker compared with patients without DM (13.5% vs 10.3%, P =.003), an association that remained after multivariable adjustment (odds ratio 1.41, 95% CI 1.13-1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly versus non-DM-friendly β-blockers (Relative Risk 0.80, 95% CI 0.60-1.08). Conclusion Most DM patients were prescribed non-DM-friendly β-blockers - a practice that was associated with a trend toward worse glycemic control postdischarge. Although in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of β-blockers use in patients with DM.

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