Objective: To investigate the prevalence of beta blocker use and calcium channel blocker use in older patients with prior myocardial infarction at the time of admission to a nursing home.
Design: In a prospective study of 500 consecutive patients aged 60 years or older admitted to a nursing home, 202 (40%) had electrocardiographic evidence of Q-wave myocardial infarction at the time of admission. The prevalence of beta blocker use and of calcium channel blocker use was investigated in these 202 patients with previous myocardial infarction. The prevalence of beta blocker use and of calcium channel blocker use was also investigated in patients with myocardial infarction and abnormal left ventricular (LV) ejection fraction.
Setting: A large long-term health care facility.
Patients: The patients included 344 women and 156 men, mean age 81 +/- 8 year (range 60 to 100).
Measurements and main results: Of 500 patients, 202 (40%) had Q-wave myocardial infarction at the time of admission to the nursing home. Seventeen (8%) of these 202 patients with myocardial infarction were receiving beta blockers and 74 (37%) were receiving calcium channel blockers at the time of admission. Of 171 patients with myocardial infarction who had technically adequate measurements of LV ejection fraction, 59 (35%) had an abnormal LV ejection fraction (< 50%). Of the 59 patients with previous myocardial infarction and abnormal LV ejection fraction, four (7%) were receiving beta blockers and 19 (32%) were receiving calcium channel blockers at the time of admission.
Conclusions: Beta blockers are underutilized, and calcium channel blockers are overutilized in the treatment of older patients with a history of myocardial infarction at the time of admission to a nursing home.