| Autor: |
Rochon, Paula A., Anderson, Geoffrey M., Tu, Jack V., Clark, Jocalyn P., Gurwitz, Jerry H., Szalai, John Paul, Lau, Paula |
| Předmět: |
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| Zdroj: |
Canadian Medical Association Journal (CMAJ); 11/30/99, Vol. 161 Issue 11, p1403-1408, 6p, 3 Charts |
| Abstrakt: |
AbstractBackground:Despite its proven efficacy, BETA-blocker therapy remains underused in elderly patients after myocardial infarction (MI). The objectives of this study were to identify undertreated groups of seniors and to determine whether older and frailer patients are being selectively dispensed low-dose BETA-blocker therapy.Methods:From a comprehensive hospital discharge database, all people aged 66 years or more in Ontario who survived an acute MI between April 1993 and March 1995 were identified and classified into those who did not receive BETA-blocker therapy and those dispensed low, standard or high doses of this agent. Logistic regression models were used to study the effect of age, sex, comorbidity, potential contraindications to BETA-blocker therapy and residence in a long-term-care facility on the odds of not being dispensed a BETA-blocker. Among BETA-blocker users, the odds of being dispensed low relative to standard or high doses of this agent were evaluated.Results:Of the 15 542 patients, 7549 (48.6%) were not dispensed a BETA-blocker. Patients 85 years of age or more were at greater risk of not receiving BETA-blocker therapy (adjusted odds ratio [OR] 2.8, 95% confidence interval [CI] 2.5-3.2) than were those 66 to 74 years. Having a Charlson comorbidity index of 3 or greater was associated with an increased risk of not receiving BETA-blocker therapy (adjusted OR 1.5, 95% CI 1.3-1.8) compared with having lower comorbidity scores. Patients who resided in a long-term-care facility were at increased risk of not being prescribed BETA-blocker therapy (adjusted OR 2.6, 95% CI 2.0-3.4). Among the 5453 patients with no identifiable contraindication to BETA-blocker therapy, women were significantly less likely than men to receive this agent (p = 0.005). Of the 6074 patients who received BETA-blockers, 2248 (37.0%) were dispensed low-dose therapy. Patients aged 85 years or more had an increased risk of being dispensed low-dose therapy (adjusted OR 1.6, 95... [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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