Risk vs Benefits of Post-MI Beta-Blockers in Nursing Home Residents

JAMA Intern Med 2016 Dec 12

Beta-blockers are known to prevent early mortality after an MI, but they are often not prescribed in elderly NH patients due to fear that they can worsen functional decline.

Researchers studied linked Medicare claims and NH data on 11,000 NH residents (mean age, 84; mostly white women).  Post-MI patients discharged on B-blockers were matched with equal number who did not receive B-blockers.

NNH:  52 would need to be treated for 1 to have accelerated functional decline; highest risk group was those already with moderate-to-severe cognitive or functional impairment.

NNT:  26 patients would need to be treated with B-blocker to prevent 1 death.

Take-home point:  Shared decision-making necessary for prescribing beta-blockers in the post-MI setting to frail elderly NH patients.  What are the goals of treatment?  What is the risk vs benefit in the patient’s and family’s eyes?

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