Abstract
Objective
Our purpose was to examine the association between beta-blocker dose and mortality
following acute myocardial infarction.
Methods
This nationwide cohort study enrolled all patients admitted for first-time acute myocardial
infarction in Denmark between July 1, 2004 and December 31, 2014, using the Danish
National Patient Registry. Patients alive 15 days after admission were followed until
death, emigration, or December 31, 2014. Patients were categorized according to daily
beta-blocker consumption (0%, >0%-12.5%, >12.5%-25%, >25%-50%, >50%-100%, or >100%
of the currently recommended target dose) based on prescriptions registered in the
Danish National Database of Reimbursed Prescriptions. Doses were continuously updated
during follow-up. Mortality rate ratios (MRRs) were computed and adjusted for confounders
using Cox proportional hazard regression.
Results
Among 65,125 patients followed, any beta-blocker dose was associated with significant
mortality reduction compared with no treatment (adjusted MRR ≤ 0.92 [95% confidence
interval {CI}: 0.86-0.98]). The largest reduction was observed within the first year
for beta-blocker doses >25%-50% (adjusted MRR = 0.55 [95% CI: 0.50-0.60]). After 1
year, doses >50%-100% were associated with the largest mortality reduction (adjusted
MRR = 0.58 [95% CI: 0.50-0.67]), but it did not differ significantly from that associated
with doses >25%-50% (adjusted MRR = 0.68 [95% CI: 0.61-0.77]).
Conclusions
Any beta-blocker dose was associated with significant mortality reduction following
acute myocardial infarction compared with no treatment. Doses >25%-50% of the currently
recommended target dose were associated with maximal mortality reduction within the
first year after acute myocardial infarction, suggesting that higher doses are unnecessary.
Keywords
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Article info
Publication history
Published online: February 20, 2023
Accepted:
February 1,
2023
Received:
February 1,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: JJG was supported by grant #5U01HL080416 from the National Heart, Lung, and Blood Institute of the National Institutes of Health and the Miami Heart Research Institute. None of the funders had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, approval of the manuscript, or decision to submit the manuscript for publication.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
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