Consideration of Features of beta-blocker Medication after Acute Myocardial Infarction in the Emergency Department

Kim, Ho Gwan; Jeong, Tae Oh; Jin, Young Ho; Lee, Jae Baek

Abstract

PURPOSE: To assess factors that influcence beta-blocker use in ST-segment elevation myocaridal infarction (STEMI) in the emergency department (ED) and to identify features related to beta-blocker use.
METHODS
A retrospective study was conducted of STEMI ED patients presenting to tertiary hospital ED from January 2005 to December 2006. Two hundred eighty-seven patients were enrolled. Chi2 analysis was used to assess beta-blocker usage.
RESULTS
Two hundreds eighty-seven patients were identified. Total patients eligible for beta-blocker were 241 (84%). Of these, 234 (97%) received a beta-blocker in the ED. Two hundreds twelve patients (73.9%) were male and, 166 patients (57.8%) were over sixty years of age. Eligibility of patients for beta-blocker was not different by gender or age. Only 39 (13.6%) did not take beta-blocker. Although 46 patients had contraindications. Seven patients eligible for beta-blocker did not take the drug and there were inadvertent medications of 14. We categorized all patients receiving beta-blocker into three groups; early, normal, and delayed drug administration. Of 248 patients, 148 (59.6%) were early, 50 (20.2%) were normal, 50 (20.2%) were delayed. There were no differences in the three groups by gender (p=0.869). Only 22 patients received beta-blockers from emergency physicians (EP). All inadvertents medications were administered by internists.
CONCLUSION
Several articles have reported underutilization of beta-blocker according to age and gender. In the present study, however, there appears to be no age or gender difference suggesting improvement in practices with beta-blocker. Of concern, though, is the large number of patients (50) who received drug only after more than twelve hours (door to drug time) in the ER. This indicates that although practices of medication were improved in the ER, adequacy and appropriateness of medication is not good. Therefore, an education program for beta-blocker use should be directed towards early medication (especially within two hours). In addition, beta-blocker administration by EPs should be emphasized because of their close early contact with patients.