Mortality from a second myocardial infarction

Beta-blockers are used to treat a variety of problems, including high blood pressure, arrhythmia, and angina, and they have been shown to reduce the risk of recurrent heart attacks and death in people who have already suffered a heart attack (Gottlieb, McCarter & Vogel, 1998). The use of beta-blockers has been estimated to reduce the risk of cardiovascular death by 22 percent, and to reduce the risk of nonfatal reinfarction by 27 percent (McCormick et al 1999). Patients who have already had a heart attack are at a particularly high risk of a recurrent MI and death. However, many physicians are reluctant to prescribe these drugs for patients with severe congestive heart failure because they can sometimes worsen the condition. Side-effects of beta-blockers include depression, fatigue, and impaired sexual function, and in a Beta-Blocker Heart Attack Trial, 13 percent of patients were withdrawn from the medication because of side-effects during a two-year followup (Beta-Blocke

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from 23 percent before the MI to 49 percent in the 90 days after the event. Those most likely to receive beta-blockers were those aged 65 to 74 years. The reduction in mortality in the patients prescribed beta-blockers was seen across all age groups from 64 years of age to 85 years of age. Moreover, in the patients eligible for beta-blockers but receiving prescriptions for calcium channel blockers, the mortality risk was doubled. Hospital admissions were 22 percent lower in those patients taking beta-blockers than in those taking other medications. Gottlieb et al (1998) examined the records of more than 200,000 patients with myocardial infarction, 34 percent of whom had been prescribed beta-blockers at the time of their hospital discharge. Treatment with beta-blockers resulted in a reduction in mortality of 40 percent in post-MI patients who had no other complicating medical problems. Reductions were also seen in mortality in patients with chronic obstructive pulmonary disease (40 percent) and diabetes mellitus (36 percent). It was estimated that if beta-blockers had been prescribed more widely to this group of patients, more than 10,000 deaths could have been prevented. A study examined the effectiveness of be
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Approximate Word count = 1380
Approximate Pages = 6 (250 words per page)

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